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Clinical and Inflammatory Outcomes of Rotational Atherectomy in Calcified Coronary Lesions: A Systematic Review and

Az Hafid Nashar1,2, Andriany Qanitha2,3, Abdul Hakim Alkatiri1,2

  • 1Pusat Jantung Terpadu (Makassar Cardiac Center), Dr. Wahidin Sudirohusodo General Teaching Hospital, Makassar 90245, South Sulawesi, Indonesia.

Journal of Clinical Medicine
|August 14, 2025
PubMed

Insights

Rotational atherectomy (RA) for calcified coronary arteries increases long-term risks of major adverse cardiovascular events (MACEs) and mortality compared to other interventions. Short-term outcomes are similar, but careful patient selection is crucial.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Coronary artery calcification poses challenges for percutaneous coronary intervention (PCI).
  • Rotational atherectomy (RA) is used to treat severely calcified coronary lesions.
  • Comparative outcomes of RA versus other interventions require thorough assessment.

Purpose of the Study:

  • To compare clinical and inflammatory outcomes of rotational atherectomy (RA) versus other interventions in patients with calcified coronary arteries.
  • To evaluate the safety and efficacy of RA in managing complex coronary lesions.

Main Methods:

  • Systematic literature search of PubMed (Medline) and Embase databases.
  • Adherence to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and PICO criteria.
  • Meta-analysis of 110 articles involving over 2.3 million patients with moderate to severe coronary calcified lesions.

Main Results:

  • Pooled short- to mid-term major adverse cardiovascular events (MACEs) were 6%, increasing to 17% at 6 months; mortality was 2% within 6 months, rising to 7% thereafter.
  • Rotational atherectomy (RA) significantly increased long-term MACEs, mortality, total lesion revascularization (TLR), bleeding, and fluoroscopy time.
  • RA showed similar short-term MACEs and mortality risks compared to other procedures, with a potential reduction in coronary dissection risk.

Conclusions:

  • Rotational atherectomy (RA) is associated with higher long-term risks of MACEs, mortality, TLR, bleeding, and fluoroscopy time compared to alternative interventions.
  • Short-term outcomes for RA are comparable to other procedures, but careful patient selection is essential due to increased long-term risks.
  • The findings highlight the need to weigh the benefits against the long-term risks of RA in managing calcified coronary lesions.

Keywords:
calcified coronary arteryclinical outcomesinflammationinterleukin-6rotational atherectomy

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