Rotational atherectomy and new-generation drug-eluting stent implantation

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Device Technology

Background:

• Complex coronary artery disease often involves extensive calcified and fibrotic plaque, posing challenges for percutaneous coronary intervention.
• Rotational atherectomy (RA) is used for plaque modification in such complex lesions.
• The clinical outcomes of RA followed by new-generation drug-eluting stent (DES) implantation for these challenging lesions require thorough evaluation.

Purpose of the Study:

• To evaluate the clinical outcomes of rotational atherectomy (RA) followed by new-generation drug-eluting stent (DES) implantation.
• To assess the safety and efficacy of this combined approach in patients with extensive calcified and fibrotic plaque.
• To identify predictors of adverse clinical events, including all-cause death and target vessel failure (TVF).

Main Methods:

• Retrospective analysis of 744 consecutive patients (770 lesions) treated with RA and new-generation DES.
• Inclusion criteria: de novo lesions with extensive calcified and fibrotic plaque.
• Clinical outcomes at 12 months were evaluated, and Cox regression models were used to identify predictors of all-cause death and TVF.

Main Results:

• Low rates of target lesion revascularization (2.9%) and TVF (6.6%) were observed at 12 months.
• Predictors of 12-month mortality included hemodialysis, non-ST-segment elevation acute coronary syndrome, low ejection fraction, and HbA1c ≥ 7%.
• Hemodialysis and right coronary artery involvement were independent predictors of TVF.

Conclusions:

• Rotational atherectomy (RA) followed by new-generation drug-eluting stent (DES) implantation is a recommended strategy for patients with excessive calcified and fibrotic plaque.
• This combined approach is associated with favorable clinical outcomes.
• Effective plaque debulking with RA is crucial for improving outcomes in complex coronary lesions.