Safety, efficacy, and outcomes of the modified rotational atherectomy approach: A real-world single-center experience

Area of Science:

• Interventional Cardiology
• Cardiovascular Medicine
• Medical Device Technology

Background:

• Rotational atherectomy (RA) effectively ablates calcified coronary plaques, aiding stent expansion.
• However, RA carries risks including coronary perforation, dissection, and slow/no-reflow.
• Optimizing RA safety and outcomes in diverse patient populations remains crucial.

Purpose of the Study:

• To assess the safety and periprocedural outcomes of a modified RA approach in Indian patients.
• To evaluate the efficacy of specific techniques in reducing RA-associated complications.

Main Methods:

• A 6-year retrospective study of 320 patients undergoing modified RA at an Indian tertiary care institution.
• The modified approach involved slow burr speed (150,000-155,000 rpm), short runs, and pretreatment with adrenaline and aminophylline to avoid temporary pacemakers (TPM).
• Data collected included demographics, procedural details, and complications; primary endpoint was angiographic and procedural success.

Main Results:

• The study included predominantly male patients (80.31%) with high rates of acute coronary syndrome (67.81%), diabetes (50.93%), and hypertension (67.81%).
• A total of 322 RA procedures on 414 lesions were performed, including chronic total occlusions and left main coronary artery lesions.
• Procedural success was high (96.90%), with low complication rates: slow/no-reflow (1.24%), dissection (1.24%), and burr entrapment (0.62%). TPM was needed in only one patient (0.31%).

Conclusions:

• A modified RA technique, incorporating slow burr speed, short runs, and specific pretreatment, can be safely performed in an Indian setting.
• This approach effectively avoids the need for temporary pacemakers and reduces the incidence of slow/no-reflow.
• Small burr sizes, slow rotation speeds, and short runs are critical for safe and effective calcium ablation using RA.