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Safety and Workflow Using Rotational Atherectomy in Non-Surgical Centres-The SWAN Study.

Samantha L Saunders1, Ganeev Malhotra2, Kelsey Gardiner3

  • 1Cardiology Department, Gosford Hospital, Gosford, NSW, Australia; School of Medicine and Public Health, The University of Newcastle, NSW, Australia.

Heart, Lung & Circulation
|December 27, 2025
PubMed
Summary
This summary is machine-generated.

Rotational atherectomy (RA) for high-risk percutaneous coronary intervention (PCI) is safe without on-site surgical backup. This finding is crucial for improving regional access to RA-assisted PCI in Australia.

Keywords:
Burr entrapmentCoronary perforationNo/slow-reflow phenomenonRotational atherectomy

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Historically, high-risk percutaneous coronary intervention (PCI) procedures like rotational atherectomy (RA) necessitated on-site surgical support.
  • Advancements in PCI techniques and Australia's dispersed population necessitate re-evaluating RA's role in contemporary practice.

Purpose of the Study:

  • To assess the safety and outcomes of rotational atherectomy (RA) performed at hospitals without on-site cardiac surgery.
  • To determine the feasibility of RA in non-surgical centers, particularly in geographically dispersed regions.

Main Methods:

  • Analysis of consecutive RA PCI cases from September 2012 to February 2024 across seven Australian hospitals lacking on-site surgical backup.
  • Primary outcome measures included emergency cardiac surgery referrals (bailout) and 30-day mortality.

Main Results:

  • 943 patients underwent RA; only 0.4% required off-site surgical bailout.
  • Major complications like perforation (0.8%) and tamponade (0.8%) were rare.
  • 30-day mortality was 3.4%, with only 0.8% directly attributed to RA complications.

Conclusions:

  • Rotational atherectomy can be safely performed without on-site surgical backup, even in regional Australian settings.
  • Maintaining regional access to RA-assisted PCI is vital for geographically dispersed populations.
  • Percutaneous management effectively addresses rare but severe RA complications like tamponade, perforations, and burr entrapment.