Halftime rotational atherectomy: a unique concept for diffuse long severely calcified lesions

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Rotational atherectomy (RA) is challenging in diffuse calcified lesions.
• A novel technique, 'halftime' RA, involving a break during the procedure, was explored.
• This study investigates the safety of halftime RA compared to standard RA.

Purpose of the Study:

• To compare periprocedural complications, specifically myocardial infarction (MI), between rotational atherectomy with and without a halftime break.
• To evaluate the safety and efficacy of the halftime technique in treating diffuse, severely calcified coronary lesions.

Main Methods:

• A retrospective study included 177 diffuse long severely calcified lesions (≥30 mm) requiring RA.
• Lesions were divided into a halftime group (n=29) and a no-halftime group (n=148).
• The primary outcome was periprocedural myocardial infarction (MI).

Main Results:

• The halftime group had smaller reference diameters (1.82 mm vs 2.17 mm) and longer total run times (133.0s vs 71.5s).
• While creatinine kinase (CK) and CK-myocardial band (MB) levels were higher in the halftime group, no periprocedural MI occurred in this group.
• No significant difference in MI rates was observed between the groups, with zero events in the halftime group.

Conclusions:

• Periprocedural myocardial infarction was not observed in patients undergoing rotational atherectomy with a halftime break.
• Halftime rotational atherectomy may represent a safe adjunctive strategy for managing diffuse, severely calcified coronary lesions.
• Further research is warranted to confirm the safety and efficacy of this technique.