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Published on: May 29, 2015
Single centre experience of rotablation-assisted left main percutaneous coronary intervention
Mohd Maqbool Sohil1, Ishtiyaq Masood2, Dixit Goyal2
1Paras Hospital Srinagar Jammu and Kashmir, India.
Insights
Rotablation-assisted percutaneous coronary intervention (PCI) is a safe and effective treatment for complex left main coronary artery disease, especially in patients with severe calcification. This approach demonstrates good procedural success and favorable two-year clinical outcomes in Indian patients.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Technology
Background:
- Coronary Artery Bypass Grafting (CABG) has limitations for left main disease, particularly in patients with high SYNTAX scores or surgical risk.
- Limited access to CABG and a lack of long-term outcome data for rotablation-assisted PCI in Indian patients with left main lesions.
- This study addresses the need for data on rotablation-assisted PCI for complex left main disease in India.
Purpose of the Study:
- To evaluate the safety and efficacy of rotablation-assisted PCI for left main coronary artery disease.
- To assess in-hospital and two-year clinical outcomes in patients undergoing this procedure.
- To identify predictors of adverse outcomes in a subgroup analysis.
Main Methods:
- A prospective observational study of 45 consecutive patients undergoing rotablation-assisted left main PCI.
- Assessment of baseline characteristics, procedural details, and in-hospital and two-year outcomes.
- Detailed analysis of lesion complexity, including SYNTAX scores and calcification, and the techniques used (e.g., intravascular ultrasound, two-stent strategies).
Main Results:
- The patient cohort presented with complex coronary artery disease (SYNTAX score 40.1 ± 8.2), with 86.7% having severe calcification.
- Rotablation-assisted PCI achieved 100% angiographic success and 97.8% procedural success, with a low in-hospital mortality of 2.2%.
- At two years, the major adverse cardiovascular events (MACE) free survival rate was 93.3%.
Conclusions:
- Rotablation-assisted PCI is a safe and effective strategy for treating severely calcified left main coronary artery lesions.
- The procedure offers good procedural success rates.
- Favorable mid-term clinical outcomes support its use in selected patient populations.
Background:
CABG has limitations as a treatment modality in patients with Left main disease and high synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. Some patients are unsuitable for surgery owing to high surgical risk. Importantly, limited centers are offering CABG, particularly in our part of the world. Limited data exist on long-term outcomes in Indian patients undergoing rotablation-assisted PCI for such lesions. Our objective was to assess in-hospital and two-year clinical outcomes of patients undergoing rotablation-assisted left main PCI at our center.
Methods:
This prospective observational study included 45 consecutive patients undergoing rotablation-assisted left main PCI from January 2020 to January 2023. Baseline characteristics, procedure-related factors, in-hospital, and two-year outcomes were assessed. Subgroup analysis was done to assess the predictors of adverse outcomes.
Results:
Our cohort had anatomically complex coronary artery disease with a SYNTAX score of 40.1 ± 8.2. 86.7 % (n = 39) of patients had severe angiographic calcification. Intravascular ultrasound (IVUS) was done in 75.6 % of patients (n = 34). 71.1 % (n = 32) of patients had a true bifurcation lesion. Rotablation was performed using Rotablator RA system. The target burr-artery ratio was 0.7. Burrs used were sized from 1.25 mm to 2 mm and were operated at speeds of 140,000 to 180,000 rpm. Multiple burrs were used when clinically necessary. 75.6 % (n = 34) of patients were done by the two-stent technique. Double kissing CRUSH (DK CRUSH) was the most common two-stent technique used in 71.1 % (n = 32) patients. Angiographic success was 100 %, while procedural success was 97.8 %. In-hospital mortality was 2.2 %. At two years, major adverse cardiovascular events (MACE) free survival was 93.3 %.
Conclusion:
Rotablation-assisted PCI in severely calcified left main lesions is safe and effective, offering good procedural success and favourable mid-term clinical outcomes.
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