Clinical impact of direct rotational atherectomy in patients with complex coronary artery lesions

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Optimal timing for rotational atherectomy (RA) in percutaneous coronary intervention (PCI) remains under-explored.
• Severe coronary artery calcification presents challenges for successful PCI.
• Limited data exists on the clinical impact of early RA application.

Purpose of the Study:

• To evaluate the clinical impact of early versus indirect application of rotational atherectomy (RA) in patients with severe coronary artery calcification undergoing PCI.
• To assess the effect of direct RA on procedural success and adverse events.
• To determine if early RA strategy reduces in-hospital complications.

Main Methods:

• Retrospective analysis of 581 consecutive lesions from 9 tertiary centers (January 2010 - October 2019).
• Patients underwent PCI with RA for severe coronary artery calcification.
• Direct RA defined as RA use before balloon expansion ≥2.0 mm; indirect RA involved other sequences.

Main Results:

• Direct RA was used in 62.0% of lesions (360/581).
• Technical success rate was significantly higher in the direct RA group (97.5%) compared to the indirect RA group (93.7%, p=0.021).
• The primary endpoint (technical failure or severe dissection) was significantly lower in the direct RA group (11.9%) versus the indirect RA group (24.4%, p<0.001).
• Multivariate analysis showed indirect RA increased the risk of the primary endpoint (OR 2.512, p<0.001).

Conclusions:

• Early application of rotational atherectomy (direct RA) is associated with higher technical success rates.
• The direct RA strategy significantly reduces the incidence of procedural complications and adverse events.
• Implementing RA early in the PCI procedure may improve patient outcomes and reduce in-hospital events.