Comparison of Two Different Rota-Flush Solutions in Patients Undergoing Rotational Atherectomy: A Randomized,...

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Rotational atherectomy (RA) is a key procedure for treating complex coronary artery disease.
• Ensuring procedural safety and efficacy, particularly regarding complications like slow flow/no-reflow and coronary spasm, is crucial.
• Evaluating novel solutions like heparin rota-flush is essential for optimizing RA outcomes.

Purpose of the Study:

• To assess the feasibility and safety of using heparin rota-flush solution during rotational atherectomy (RA).
• To compare the incidence of slow flow/no-reflow and other complications between heparin rota-flush and traditional rota-flush solutions.
• To determine the optimal flushing strategy for RA procedures.

Main Methods:

• A prospective study involving 200 patients undergoing RA between August 2019 and November 2021.
• Patients were randomized into two groups: heparin rota-flush (n=103) and traditional rota-flush (n=97).
• Primary endpoint: slow flow/no-reflow. Secondary endpoints: procedural success, complications, and major adverse cardiovascular events (MACE).

Main Results:

• No significant difference in slow flow/no-reflow incidence (29.1% vs. 19.6%, P=0.117) or procedural success (97.1% vs. 93.8%, P=0.320) between groups.
• Coronary spasm incidence was significantly higher in the heparin rota-flush group (42.7% vs. 22.7%, P=0.003).
• Severe hypotension and MACE rates were comparable between the groups.

Conclusions:

• Heparin rota-flush solution does not increase slow flow/no-reflow but significantly increases coronary spasm during RA.
• Traditional rota-flush solutions without RotaGlide appear more effective in preventing coronary spasm.
• Routine use of heparin rota-flush solution is not supported for RA procedures based on these findings.