Planned vs. rescue rotational atherectomy in severe coronary calcification: procedural complications and one-year

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Xiaogang Liu1, Lei Wan1, Yufeng Liu1

  • 1Department of Cardiology, Wuhan Fourth Hospital, Wuhan, China.

Frontiers in Cardiovascular Medicine
|July 4, 2025
PubMed

Insights

Planned rotational atherectomy (pRA) and rescue rotational atherectomy (rRA) both show similar one-year outcomes for treating severe coronary calcification. However, rescue RA is linked to increased procedural complications and longer procedure times compared to planned RA.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Current guidelines suggest rotational atherectomy (RA) as a critical intervention for managing calcified or fibrotic coronary lesions.
  • Severe coronary stenosis and calcification pose significant challenges during percutaneous coronary intervention (PCI).
  • The comparative outcomes of planned RA (pRA) versus rescue RA (rRA) require further investigation.

Purpose of the Study:

  • To compare the procedural and one-year clinical outcomes of planned RA (pRA) versus rescue RA (rRA) in patients undergoing PCI for severe coronary stenosis and calcification.

Main Methods:

  • A total of 111 patients undergoing RA were retrospectively analyzed and stratified into pRA (n=84) or rRA (n=27) groups.
  • Data collected included baseline characteristics, lesion details, procedural parameters, complications, and one-year major adverse cardiovascular and cerebrovascular events (MACCE).
  • Statistical analysis, including multivariable logistic regression, was used to compare outcomes between the groups.

Main Results:

  • The rRA group required more pre-dilation balloons, had a higher incidence of coronary artery dissection, and consumed more contrast agent.
  • Contrast-induced nephropathy and procedure duration were significantly higher in the rRA group.
  • Multivariable analysis identified rRA as an independent predictor of periprocedural complications (aOR=2.83; P=0.048), despite similar one-year MACCE rates between groups (pRA 3.7% vs. rRA 4.8%; P=1.00).

Conclusions:

  • Rescue RA is associated with increased procedural complications, longer procedure times, and higher contrast agent utilization compared to planned RA.
  • Despite higher procedural risks, rescue RA demonstrates comparable one-year MACCE rates to planned RA.
  • These findings suggest that while RA is effective in both planned and rescue scenarios, careful consideration of procedural risks is warranted for rescue RA.
Abstract

Keywords:
major adverse cardiac and cerebrovascular events (MACCE)outcomeplanned rotational atherectomyrescue rotational atherectomysevere calcified lesions

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