Coronary perforation complicating rotational ablation: the U.S. multicenter experience

Area of Science:

• Interventional Cardiology
• Cardiovascular Research
• Medical Device Technology

Background:

• Rotational ablation is a key technique for treating complex coronary artery disease.
• Coronary perforation is a known but infrequent complication.
• Understanding predictors and outcomes is crucial for patient safety.

Purpose of the Study:

• To determine the incidence of coronary perforation during rotational ablation.
• To identify angiographic predictors of perforation.
• To evaluate clinical outcomes following perforation.

Main Methods:

• Retrospective analysis of the U.S. Multicenter Registry for Rotational Ablation.
• Inclusion of 2953 patients and 3717 lesions.
• Categorization into groups with and without perforation; analysis of lesion morphology and artery location.

Main Results:

• Overall perforation incidence was 0.7% of procedures and 0.6% of lesions.
• Higher perforation rates observed in right (1.1%) and circumflex (1.2%) arteries vs. left anterior descending (0.06%).
• Risk factors included eccentric lesions, tortuosity, and lesion length >10 mm.

Conclusions:

• Coronary perforation is a rare complication of rotational ablation.
• Specific coronary arteries (right, circumflex) and lesion morphologies are associated with increased risk.
• Clinical outcomes varied, including major (death, surgery, MI) and minor complications.