Safety and feasibility of rotational atherectomy in chronic total occlusion: a systematic review and meta-analysis

There is a lack of data available on the feasibility of rotational atherectomy (RA) in chronic total occlusion (CTO) lesions compared to RA in non-CTO lesions. So, we aimed to study the safety and feasibility of RA in patients with CTO lesions compared to non-CTO lesions.

We searched PubMed, Scopus, Web of Science (WOS), and Ovid until March 2024. We included all relevant studies assessing RA in CTO lesions versus non-CTO lesions. The primary outcome of interest was major adverse cardiovascular events (MACE), while secondary outcomes were all-cause death, cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR). Other studied angiographic outcomes were vessel perforation, technical success, and procedural success. The pooled data was analyzed using odds ratio (OR) with its 95% CI in using a random-effect model.

Four studies comprising 1925 patients were included in the analysis. The pooled analysis showed that RA in CTO lesions was associated with higher rates of vessel perforation (OR = 3.56, 95% CI: 1.59-7.98, p < 0.001) compared to the non-CTO lesions. On the other hand, no significant differences were observed regarding studied clinical outcomes and angiographic outcomes between CTO and non-CTO lesions.

RA for CTO lesions was associated with comparable clinical and angiographic outcomes. RA is a safe and feasible approach in CTO lesions, despite a higher incidence of vessel perforation. More investigations on the severity of each case should be guided in further studies.