Comparison of bailout and planned rotational atherectomy for severe coronary calcified lesions

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Severe calcified coronary lesions pose treatment challenges.
• Rotational atherectomy (RA) is an option for managing complex calcifications.
• Comparing planned versus bailout RA is crucial for optimizing patient care.

Purpose of the Study:

• To compare the outcomes of planned and bailout rotational atherectomy (RA).
• To evaluate procedural success, complications, and long-term prognosis in severe calcified coronary lesions treated with RA.

Main Methods:

• Retrospective analysis of 190 patients undergoing RA from 2017-2018.
• Patients were divided into planned RA (138) and bailout RA (52) groups.
• Comparison of procedural parameters, success rates, complications, and 3-year outcomes.

Main Results:

• Planned RA group showed significantly lower use of balloons, shorter procedure times, reduced fluoroscopy, and less contrast.
• Planned RA had higher procedural success rates (99.3% vs. 92.3%) and lower complication incidence (4.3% vs. 17.3%).
• No significant difference in primary outcomes at 3 years between planned and bailout RA groups (9.2% vs. 16.6%).

Conclusions:

• Planned RA improves immediate procedural success and reduces complications in severe calcified coronary lesions.
• Despite short-term benefits, planned RA does not appear to improve long-term prognosis compared to bailout RA.
• RA strategy choice should consider procedural efficiency and complication reduction while acknowledging similar long-term results.