Intravascular Ultrasound-Guided Planned Rotational Atherectomy for Grade Ⅲ Coronary Calcified Stenose Versus Cutting
Haijia Yu1, Liujie Li1, Jugang Chen1
1Department of Cardiology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
Insights
Intravascular ultrasound (IVUS)-guided planned rotational atherectomy (RA) shows higher success and better stent expansion for moderate to severe coronary calcified lesions (CCL) compared to cutting balloons (CB). This approach offers a valuable pretreatment option for complex coronary artery disease.
Area of Science:
- Interventional Cardiology
- Cardiovascular Imaging
- Medical Device Technology
Background:
- Planned rotational atherectomy (RA) is established for severe coronary calcified lesions (CCL).
- Bailout RA is recommended for moderate to severe CCL, but planned approaches require further evaluation.
- Cutting balloons (CB) are an alternative for moderate to severe CCL.
Purpose of the Study:
- To compare the efficacy of intravascular ultrasound (IVUS)-guided planned rotational atherectomy (RA) versus cutting balloons (CB).
- To assess outcomes in patients with moderate to severe coronary calcified lesions (CCL).
- To determine if planned RA offers superior strategy success and stent expansion.
Main Methods:
- Randomized trial of 80 patients with grade III CCL, assigned to either planned RA or CB.
- Primary endpoint: strategy success. Coprimary endpoint: stent expansion.
- Secondary endpoints: procedural costs, duration, contrast volume, stent thrombosis, and 30-day MACE.
Main Results:
- Planned RA group demonstrated significantly higher strategy success (95% vs. 80%, P=0.043).
- Superior stent expansion indices (expansion rate, minimal stent area, asymmetry) were observed in the RA group (P<0.05).
- RA group had higher X-ray dose, contrast volume, and procedural expense, but no difference in procedural duration or 30-day MACE.
Conclusions:
- IVUS-guided planned RA for grade III CCL achieves higher strategy success and better stent expansion than CB.
- The RA strategy is associated with rare procedural complications and low 30-day MACE.
- Planned RA provides valuable insight as a pretreatment option for moderate to severe CCL.
Abstract:
Planned rotational atherectomy (RA) has been widely used for severely calcified lesions, but moderate to severe coronary calcified lesions (CCL) are recommended for bailout RA. In this study, we sought to clarify whether intravascular ultrasound (IVUS)-guided planned RA is superior to cutting balloons (CB) for moderate to severe CCL. Patients with grade Ⅲ CCL were randomly assigned to percutaneous coronary intervention with RA or CB. The primary endpoint was strategy success and the coprimary endpoint was stent expansion. Secondary endpoints included procedural expense and duration, contrast amount, stent thrombosis, and major adverse cardiac events (MACE) at 30 days. A total of 80 patients (65.4 ± 8.0 vs 62.4 ± 11.2 years, p = 0.144) were enrolled, 40 in each group. Prior myocardial infarction was present in 2 (5%) versus 8 (20%) patients, p = 0.043. Strategy success rate was higher with planned RA compared with CB (95% vs 80%, p = 0.043). Stent expansion indices (stent expansion rate >80%, minimal stent area >5.0 mm², and stent asymmetry) were significantly better in the RA group (p <0.05). X-ray dose, contrast amount, and procedural expense were higher in the RA group (p <0.05), but no significant differences in procedural duration or 30-day MACE were observed between groups (p >0.05). In conclusion, IVUS-guided planned RA for grade Ⅲ CCL results in higher strategy success and better stent expansion than CB, with rare procedural complications and few clinical adverse events at 30 days, providing novel insight into pretreatment of moderate to severe CCL.
