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High frequency rotational ablation: an alternative in treating coronary artery stenoses and occlusions
U Dietz1, R Erbel, H J Rupprecht
1Second Medical Clinic, Johannes Gutenberg University, Mainz, Germany.
Insights
High frequency rotational ablation is safe and effective for coronary artery stenoses and occlusions. Combining it with balloon angioplasty improves success rates, offering results comparable to traditional methods.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Device Technology
Background:
- Coronary artery disease remains a leading cause of mortality worldwide.
- Percutaneous coronary intervention (PCI) is a primary treatment modality.
- Advanced techniques are needed to address complex coronary lesions.
Purpose of the Study:
- To evaluate the safety and efficacy of high-frequency rotational ablation for coronary artery stenoses and occlusions.
- To compare outcomes with traditional percutaneous transluminal coronary angioplasty (PTCA).
Main Methods:
- A study involving 106 patients with significant coronary stenoses (type B and C) and chronic occlusions.
- High-frequency rotational ablation was performed, often in combination with PTCA.
- Outcomes included diameter stenosis reduction, restenosis rates, and complications.
Main Results:
- Initial success rates for rotational ablation were 60% for stenoses and 39% for occlusions.
- Combined therapy increased success to 79% and 54%, respectively.
- Restenosis rates at six months varied, with no procedural deaths but some non-Q wave infarctions and coronary spasm.
Conclusions:
- High-frequency rotational ablation is a safe and effective option for complex coronary lesions.
- Combined rotational ablation and balloon angioplasty is feasible and often necessary.
- Outcomes are comparable to conventional balloon angioplasty, with potential for improved lumen gain.
Objective:
To prove the safety and effectiveness of high frequency rotational ablation of coronary artery stenoses and occlusion in humans.
Subjects:
106 patients with symptoms (91 men, 15 women) who had 67 significant stenoses, mainly types B and C, and 46-chronic occlusions.
Main Outcome Measures:
Mean change in diameter stenosis after rotational angioplasty alone and in combination with percutaneous transluminal coronary angioplasty immediately after treatment and 24 hours and six months later; restenosis rates at six months; complication of treatment.
Results:
Rotational ablation could not be used in five stenoses and 16 chronic occlusions because of inability to reach or cross the lesion with the Rotablator guide wire. In four cases rotational ablation failed. Initial angiographic and clinical success by rotational ablation was achieved in 40 of the 67 stenoses (60%) and in 18 of the 46 chronic occlusions (39%). Additional balloon angioplasty was performed in 45 patients, increasing the success rates to 79% and 54%, respectively. In the 62 stenoses treated by rotational ablation the angiographic diameter stenoses were reduced from 76% (SD 14%) to 32% (14%) after Rotablator treatment alone and from 75% (11%) to 33% (17%) with additional balloon angioplasty. In the 30 chronic occlusions treated by rotational ablation the angiographic diameter stenoses were reduced to 38% (18%). At six months angiographic restenosis was evident in nine of the 25 (36%) stenoses treated with rotational ablation alone, in seven of the 22 (32%) stenoses treated with rotational and balloon angioplasty, and in 14 of the 24 (58%) chronic occlusions. There were no procedural deaths and two patients (2%) underwent emergency coronary artery bypass grafting. Although no transmural infarction occurred, there were five (6%) non-Q wave infarctions (two embolic side branch occlusions, two subacute occlusions, and one acute occlusion). Clinically insignificant slight increases in creatine kinase activity were seen in five patients (6%). Severe coronary artery spasm unresponsive to medical treatment was provoked in seven cases (8%).
Conclusions:
High frequency rotational ablation is a safe and effective method for treating type B and C coronary artery lesions with results comparable to percutaneous transluminal coronary balloon angioplasty. The combined use of rotational ablation and balloon angioplasty is feasible and is necessary in about half of all procedures, in most cases because the lumen created by the biggest burr is too small.