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Kidney disease, diabetes, and diameter stenosis predict Rotablation bailout in modified balloon application for
Dominik Felbel1, Ali Fattom1, Isabella Fechter1
1Department of Cardiology, Angiology, Pneumology and Intensive Care, Ulm University Heart Center, Ulm, Germany.
Insights
For severely calcified coronary lesions, switching from modified balloon (MB) to Rotablation (RA) treatment increases procedural risks. Consider upfront RA for complex cases to avoid complications.
Area of Science:
- Interventional Cardiology
- Cardiovascular Disease Management
- Medical Device Technology
Background:
- Modified balloon (MB) angioplasty is standard for calcified coronary lesions.
- Rotablation (RA) is sometimes required as a bailout strategy for complex cases.
Purpose of the Study:
- Identify predictors for switching from MB to RA.
- Evaluate the impact of this strategy switch on procedural and midterm outcomes.
Main Methods:
- Compared 204 patients undergoing MB treatment with 279 patients receiving upfront RA.
- Analyzed 19 patients who required a switch from MB to RA.
- Defined procedural success as successful stent implantation and TIMI III flow.
Main Results:
- The MB-to-RA switch group had lower procedural success (89.4%) versus MB-only (98.4%) and RA cohorts (96.4%).
- Switching to RA significantly increased periprocedural complications, radiation dose, and contrast volume.
- Diabetes, advanced chronic kidney disease, and high lesion stenosis independently predicted the need for strategy switch.
Conclusions:
- Upfront RA may be preferable for patients with severe calcification, high stenosis, diabetes, or renal impairment.
- Strategy switch is associated with higher periprocedural risks.
- Midterm outcomes (1-year target lesion revascularization) were not significantly affected by the strategy switch.
Background:
Modified balloon (MB) treatment in severely calcified coronary artery lesions is an established technique. However, some lesions require Rotablation (RA) as bailout strategy.
Aims:
This study aimed to assess predictors of switch from MB to RA and its impact on procedural and midterm outcomes.
Methods:
Four hundred and eighty-three consecutive patients were included undergoing MB treatment (n = 204) with a scoring or cutting balloon, or upfront RA treatment (n = 279) serving as control cohort. Strategy switch from MB to RA was performed in 19 of 204 patients. Procedural success was defined as successful stent implantation and TIMI III flow.
Results:
In the MB cohort, median age was 72 [63-78] years, 75.5% were male and 42.1% had acute coronary syndrome. Procedure success was achieved in 89.4% of the switch group versus 98.4% of the MB only group (p < 0.001) and in 96.4% of the RA cohort. In the switch group, periprocedural complications (31.6% vs. 8.1% vs. 11.8%, p = 0.007), radiation dose (149 [126-252] vs. 59 [30-97] vs. 102 [59-156] Gcm2; p < 0.001) and contrast volume (250 [190-250] vs. 190 [150-250] vs. 195 [190--250] mL; p < 0.001) were significantly higher. Diabetes (OR 3.8, 95% CI 1.1-13.9, p = 0.042), chronic kidney disease stage 4 or 5 (OR 19.0, 95% CI 3.3-108.6, p < 0.001) and pronounced calcification resulting in higher angiographic diameter stenosis (OR 1.13, 95% CI 1.1-1.2, p = 0.001) independently predicted strategy switch. Midterm results were not affected by strategy switch regarding 1-year target lesion revascularization rates (86% vs. 89% vs. 89%; log-rank p = 0.95).
Conclusion:
Primary RA strategy might be considered in patients with severely calcified coronary artery lesions with high angiographic diameter stenosis, diabetes or impaired renal function due to increased periprocedural complication rates, radiation dose, and contrast volume following strategy switch.
