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Percutaneous coronary intervention of severely/moderately calcified coronary lesions using single-burr rotational
Shuvanan Ray1, Siddhartha Bandyopadhyay1, Prithwiraj Bhattacharjee1
1Department of Cardiology, Fortis Hospital; Kolkata-India.
Insights
A modified rotational atherectomy technique safely and effectively treats calcified coronary lesions. This procedure, involving scoring balloon angioplasty, shows favorable outcomes for patients with moderate to severe calcification.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Devices
Background:
- Percutaneous coronary intervention (PCI) in calcified lesions poses challenges.
- Scoreflex balloons may fail to cross or dilate severely calcified lesions.
Purpose of the Study:
- To evaluate the safety and efficacy of a modified rotational atherectomy technique followed by scoring balloon angioplasty.
- To assess outcomes in patients with moderately and severely calcified coronary lesions.
Main Methods:
- Retrospective analysis of 144 patients with calcified coronary lesions.
- Patients underwent single-burr rotational atherectomy (burr-artery ratio ≤0.6) followed by scoring balloon dilatation (balloon-artery ratio 0.9).
- Primary endpoint: angiographic and procedural success; Secondary endpoint: major adverse cardiac events (MACE) at one year.
Main Results:
- Procedural success in 96.52% of patients.
- In-hospital death in 2.77% of patients.
- Burr rotation speed and heparin dose were associated with in-hospital MACE in severe calcification.
Conclusions:
- Modified rotational atherectomy with scoring balloon angioplasty is safe and effective.
- Favorable clinical outcomes were observed in patients with moderate to severe calcified lesions.
- This technique offers a viable option for complex coronary interventions.
Objective:
This study evaluates the safety and efficacy of percutaneous coronary intervention in moderately and severely calcified coronary lesions, which are either not crossed or dilated using a Scoreflex balloon at nominal pressure, using single-burr rotational atherectomy (burr-artery ratio, ≤0.6) followed by scoring balloon dilatation (balloon-artery ratio, 0.9).
Methods:
We retrospectively identified 144 patients with severely and moderately calcified native coronary lesions, which were either not crossed or fully opened using an appropriately sized Scoreflex balloon at nominal pressure, from a tertiary care center in India. All patients underwent rotational atherectomy. The primary endpoint was angiographic and procedural success and in-hospital clinical outcomes. The secondary endpoint was the incidence of major adverse cardiac events (MACE) at one-year clinical follow-up.
Results:
The mean age of the patients was 68.75±8.37 years, and 83.33% of them were over 60 years old. Moderate calcification was present in 21.53%, and the remaining 78.47% had severe calcification. Procedural success was achieved in 139 (96.52%) patients. In-hospital death was reported in four (2.77%) patients. Multiple regression analysis revealed that in severely calcified coronary lesions, burr rotation speed and heparin dose were significantly associated with in-hospital MACE occurrence (p=0.0337).
Conclusion:
A modified small-burr rotational atherectomy technique with scoring balloon angioplasty pre-dilatation is a safe and effective surgical procedure with favorable clinical outcomes for moderately and severely calcified coronary lesions.
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