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Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials

Abdelhakim Allali1, Mohamed Abdel-Wahab2, Karim Elbasha3

  • 1Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany. abdelhakim.allali@segebergerkliniken.de.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|April 28, 2022
PubMed

Insights

Rotational atherectomy (RA) shows improved results for calcified coronary lesions due to technical advancements and newer drug-eluting stents (DES). This analysis reviews RA

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Coronary artery calcification poses challenges for percutaneous coronary intervention.
  • Advancements in rotational atherectomy (RA) and drug-eluting stents (DES) have evolved treatment strategies.
  • Previous trials like ROTAXUS and PREPARE-CALC provide comparative data on RA versus balloon angioplasty.

Purpose of the Study:

  • To assess the technical evolution of RA in treating calcified coronary lesions.
  • To analyze RA outcomes in various patient and lesion subsets.
  • To propose recommendations for optimizing RA practice and lesion preparation.

Main Methods:

  • Pooled analysis of rotational atherectomy (RA) groups from ROTAXUS and PREPARE-CALC trials.
  • Review of recent literature on RA in calcified coronary lesions.
  • Evaluation of RA combined with other lesion preparation techniques.

Main Results:

  • Rotational atherectomy (RA) demonstrates satisfactory acute and long-term outcomes in calcified coronary lesions.
  • Technical improvements and newer generation drug-eluting stents (DES) contribute to favorable results.
  • Evidence supports RA's efficacy across diverse patient and lesion characteristics.

Conclusions:

  • Rotational atherectomy (RA) is a refined and effective modality for managing severely calcified coronary lesions.
  • A practical, evidence-based approach to RA can enhance treatment success.
  • Combining RA with other methods may further optimize lesion preparation.

Keywords:
Calcified coronary lesionsComplex percutaneous coronary interventionRotational atherectomy

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