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Safety and Feasibility of Rotational Atherectomy in Severe Aortic Stenosis

Kunwardeep S Bhatia1, Hari P Sritharan2, Usaid Allahwala2

  • 1Royal North Shore Hospital, Sydney, NSW, Australia.

Heart, Lung & Circulation
|January 22, 2022
PubMed

Insights

Rotational atherectomy (RA) is safe and feasible for treating severe aortic stenosis (AS) patients with heavily calcified coronary lesions. This procedure demonstrated a low rate of complications, supporting its use in this challenging patient group.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Surgery
  • Vascular Medicine

Background:

  • Heavily calcified coronary lesions are common in elderly patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation.
  • The use of rotational atherectomy (RA) in this population is debated due to potential increased complication risks.

Purpose of the Study:

  • To assess the safety and feasibility of rotational atherectomy (RA) in patients diagnosed with severe aortic stenosis (AS).

Main Methods:

  • A retrospective analysis was conducted on 27 patients with severe AS who underwent RA between March 2010 and September 2019.
  • Inclusion criteria required severe AS diagnosis prior to or within 8 weeks of the RA procedure.

Main Results:

  • Thirty-one lesions in 27 patients (mean age 83 years) with severe AS were treated with RA.
  • Successful stenting was achieved in all RA-treated lesions, with no instances of coronary perforation or slow-flow/no-reflow.
  • One non-RA-treated artery dissection occurred, successfully managed with a drug-eluting stent; 11.1% of patients died within one year.

Conclusions:

  • Rotational atherectomy is a feasible procedure for patients with severe aortic stenosis.
  • The study indicates a low incidence of procedural complications associated with RA in this patient cohort.
Abstract

Keywords:
Aortic valve stenosisAtherectomyCoronaryTranscatheter aortic valve replacement

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