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Rotational atherectomy for chronically and totally occluded coronary lesions: A propensity score-matched outcomes
Tien-Chien Tsai1, Wei-Jung Lo1, Wei-Jhong Chen1
1Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.
Insights
Rotational atherectomy (RA) is effective for treating chronic total occlusion (CTO) lesions that are difficult to cross or dilate. This study found RA for CTO lesions has similar safety and outcomes to non-CTO lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusion (CTO) lesions pose challenges in revascularization despite technological advancements.
- Rotational atherectomy (RA) is often required for CTO lesions that are uncrossable or undilatable with conventional devices.
Purpose of the Study:
- To evaluate the safety and efficacy of rotational atherectomy (RA) in treating chronic total occlusion (CTO) lesions.
- To compare procedural outcomes and clinical events between patients undergoing RA for CTO versus non-CTO lesions.
Main Methods:
- Retrospective analysis of consecutive patients undergoing coronary RA from a catheterization laboratory database.
- Propensity score matching was used to compare patients with CTO lesions (CTO group) undergoing RA with a control group (non-CTO group).
Main Results:
- 44 patients underwent RA for CTO lesions, compared to 37 propensity score-matched controls (non-CTO group).
- No significant differences were observed in acute procedural outcomes, contrast-induced nephropathy (CIN), or major adverse cardiovascular events (MACE) up to 1 year between the CTO and non-CTO groups.
- Patients in the CTO group had a higher incidence of diabetes and increased use of smaller burr sizes (1.25 mm).
Conclusions:
- Rotational atherectomy (RA) is a safe and effective strategy for revascularizing chronic total occlusion (CTO) lesions.
- RA for CTO lesions demonstrates comparable procedural safety and clinical outcomes to non-CTO lesions when analyzed with propensity score matching.
Background:
Despite advances being made in techniques and devices, certain chronic total occlusion (CTO) lesions remain uncrossable or undilatable. Rotational atherectomy (RA) is usually necessary for such lesions to achieve successful revascularization.
Methods:
Information regarding consecutive patients who underwent coronary RA was retrieved from the catheterization laboratory database. Patients who underwent RA for CTO lesion refractory using other conventional devices were recruited, with propensity score-matched cases serving as controls.
Results:
A total of 411 patients underwent coronary RA in the study period. Most patients had high-risk features (65.7% had acute coronary syndrome (ACS), 14.1% ischemic cardiomyopathy, and 5.1% cardiogenic shock), while only 20.2% of the patients had stable angina. Among them, 44 patients underwent RA for CTO lesions (CTO group), whereas the propensity score matched controls consist of 37 patients (non-CTO group). The baseline characteristics, high-risk features, coronary artery disease (CAD) vessel numbers, left ventricular function and biochemistry profiles of both groups were the same except for more patients with diabetes (67.6% vs. 45.5%, p = 0.046) in the non-CTO group and more 1.25 mm burr uses in the CTO group. There were no significant differences in acute procedural outcomes or incidence of acute contrast-induced nephropathy (CIN), and no patient demanded emergent CABG or died during the procedure. There was no significant difference in major adverse cardiovascular events (MACE), CV MACE or individual components between the two groups in the hospital, at 30, 90, and 180 days or at 1 year.
Conclusion:
In comparison with the propensity risk factor scores-matched controls, there was no difference in procedural complications, acute CIN or clinical outcomes during various stages of RA for CTO lesions. RA for CTO patients was highly efficient and showed safety and outcome profiles similar to those for non-CTO lesions.
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