Small-Size vs Large-Size Burr for Rotational Atherectomy

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Rotational atherectomy (RA) traditionally uses large guide catheters (≥7 Fr) for large burrs (≥1.75 mm).
• Smaller sheath and catheter sizes are associated with reduced access-site complications.
• This study investigated the feasibility of RA with smaller burrs and smaller sheath catheters.

Purpose of the Study:

• To assess the feasibility of performing rotational atherectomy (RA) using smaller burrs.
• To evaluate the use of smaller-sized sheath catheters in conjunction with smaller RA burrs.
• To analyze procedural outcomes and complications associated with different burr sizes in RA.

Main Methods:

• A retrospective analysis of 220 RA procedures performed between January 2011 and July 2017.
• Comparison of 162 patients (small-burr group, ≤1.5 mm) with 58 patients (large-burr group, >1.5 mm).
• Evaluation of clinical, procedural, safety, and feasibility data, including sheath size, catheter size, and access site.

Main Results:

• The small-burr group (≤1.5 mm) showed a high procedural success rate (93%) compared to the large-burr group (100%).
• Smaller sheath sizes (>6 Fr) were used less frequently in the small-burr group (56.0%) versus the large-burr group (89.5%).
• Radial access was more common in the small-burr group (33%) compared to the large-burr group (17%).

Conclusions:

• Rotational atherectomy (RA) can be successfully performed with smaller burrs, achieving high success rates.
• Overuse of large sheaths and catheters for small burrs was observed, indicating potential for optimization.
• Findings support the use of 6 Fr guide catheters, facilitating radial access for complex interventions.