Short-term and long-term clinical outcomes of rotational atherectomy in resistant chronic total occlusion

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Wei-Chieh Huang1, Hsin-I Teng2, Wan-Leong Chan3

  • 1Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

Journal of Interventional Cardiology
|January 10, 2018
PubMed

Insights

Rotational atherectomy (RA) is safe and effective for treating complex, calcified coronary chronic total occlusions (CTOs). This intervention shows excellent short- and long-term outcomes comparable to cases not requiring RA.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Disease Management

Background:

  • Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) can be challenging, particularly with heavily calcified lesions.
  • Rotational atherectomy (RA) is a technique used to address complex lesions during PCI.

Purpose of the Study:

  • To assess the clinical outcomes of using rotational atherectomy (RA) in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs).
  • To evaluate the safety and efficacy of RA for resistant CTO lesions, defined by heavy calcification or inability of devices to cross.

Main Methods:

  • A study of 285 patients with CTO who underwent successful PCI between January 2011 and September 2014.
  • Resistant CTO lesions were identified, and 26 patients were treated with RA.
  • Outcomes were compared between the RA group and a non-RA group, with a mean follow-up of 3.4 years.

Main Results:

  • RA successfully treated all 26 resistant CTO lesions with a high success rate (96.2%) and no major complications, except for one requiring surgery.
  • The RA group had a higher success rate (96.2%) compared to the non-RA group (89.5%, P=0.038).
  • Patients in the RA group were older, had higher J-CTO scores, and required longer stents, but demonstrated excellent and comparable 1-year and long-term clinical outcomes.

Conclusions:

  • Rotational atherectomy (RA) is a safe and feasible option for treating resistant chronic total occlusions (CTOs) characterized by heavy calcification.
  • The short- and long-term clinical outcomes following RA for CTO PCI are excellent and comparable to procedures not requiring RA.
Abstract

Keywords:
calcificationchronic total occlusioncoronary artery diseaserotational atherectomy

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