Long-term outcomes of rotational atherectomy for the percutaneous treatment of chronic total occlusions

Lorenzo Azzalini, R Dautov, S Ojeda, A Serra, S Benincasa, B Bellini, Francesco Giannini, J Chavarría, LL Gheorghe, M Pan, M Carlino, A Colombo, S Rinfret

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Abstract

Objectives. To study the long-term outcomes of rotational atherectomy (RA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background. There is little evidence on the incidence, procedural results and long-term outcomes of RA for CTO PCI. Methods. This registry included data from consecutive patients undergoing CTO PCI at four specialized centers. Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and ischemia-driven target-vessel revascularization) on follow-up were the primary endpoint. Results. A total of 1003 patients were included. Of these, 35 (3.5%) required RA. As compared with Conventional PCI, RA patients were older (68.9 ± 9.5 vs. 64.6 ± 10.7 years, P = 0.02), had higher prevalence of diabetes (58% vs. 37%, P = 0.01) and of a J-CTO score ≥2 (80% vs. 58%, P = 0.009), driven by severe calcification. Antegrade wire escalation was used more frequently in RA (74% vs. 53%, P = 0.08). RA was performed for balloon failure-to-cross in 51% and failure-to-expand in 49%. One burr was utilized in 86%. The 1.25-mm burr was the largest burr used in 43%. Slow flow/no-reflow was observed in 17%. No other serious RA-related complications were observed. Procedural success was 77% vs. 89% (P = 0.04) in RA vs. Conventional PCI. After a mean follow-up of 658 ± 412 days, MACE rates were similar between groups (15% vs. 13%, P = 0.70). Conclusions. The use of RA in CTO PCI was safe, despite a worse patient risk profile and higher procedural complexity, as compared with conventional techniques. Although procedural success was lower in the RA group, there were no differences in long-term clinical outcomes between groups. © 2016 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)820-828
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume89
Issue number5
DOIs
Publication statusPublished - 2017

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Coronary Atherectomy
Percutaneous Coronary Intervention
Therapeutics
Myocardial Ischemia
Registries
Myocardial Infarction

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Long-term outcomes of rotational atherectomy for the percutaneous treatment of chronic total occlusions. / Azzalini, Lorenzo; Dautov, R; Ojeda, S; Serra, A; Benincasa, S; Bellini, B; Giannini, Francesco; Chavarría, J; Gheorghe, LL; Pan, M; Carlino, M; Colombo, A; Rinfret, S.

In: Catheterization and Cardiovascular Interventions, Vol. 89, No. 5, 2017, p. 820-828.

Research output: Contribution to journalArticle

Azzalini, L, Dautov, R, Ojeda, S, Serra, A, Benincasa, S, Bellini, B, Giannini, F, Chavarría, J, Gheorghe, LL, Pan, M, Carlino, M, Colombo, A & Rinfret, S 2017, 'Long-term outcomes of rotational atherectomy for the percutaneous treatment of chronic total occlusions', Catheterization and Cardiovascular Interventions, vol. 89, no. 5, pp. 820-828. https://doi.org/10.1002/ccd.26829
Azzalini, Lorenzo ; Dautov, R ; Ojeda, S ; Serra, A ; Benincasa, S ; Bellini, B ; Giannini, Francesco ; Chavarría, J ; Gheorghe, LL ; Pan, M ; Carlino, M ; Colombo, A ; Rinfret, S. / Long-term outcomes of rotational atherectomy for the percutaneous treatment of chronic total occlusions. In: Catheterization and Cardiovascular Interventions. 2017 ; Vol. 89, No. 5. pp. 820-828.
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abstract = "Objectives. To study the long-term outcomes of rotational atherectomy (RA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background. There is little evidence on the incidence, procedural results and long-term outcomes of RA for CTO PCI. Methods. This registry included data from consecutive patients undergoing CTO PCI at four specialized centers. Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and ischemia-driven target-vessel revascularization) on follow-up were the primary endpoint. Results. A total of 1003 patients were included. Of these, 35 (3.5{\%}) required RA. As compared with Conventional PCI, RA patients were older (68.9 ± 9.5 vs. 64.6 ± 10.7 years, P = 0.02), had higher prevalence of diabetes (58{\%} vs. 37{\%}, P = 0.01) and of a J-CTO score ≥2 (80{\%} vs. 58{\%}, P = 0.009), driven by severe calcification. Antegrade wire escalation was used more frequently in RA (74{\%} vs. 53{\%}, P = 0.08). RA was performed for balloon failure-to-cross in 51{\%} and failure-to-expand in 49{\%}. One burr was utilized in 86{\%}. The 1.25-mm burr was the largest burr used in 43{\%}. Slow flow/no-reflow was observed in 17{\%}. No other serious RA-related complications were observed. Procedural success was 77{\%} vs. 89{\%} (P = 0.04) in RA vs. Conventional PCI. After a mean follow-up of 658 ± 412 days, MACE rates were similar between groups (15{\%} vs. 13{\%}, P = 0.70). Conclusions. The use of RA in CTO PCI was safe, despite a worse patient risk profile and higher procedural complexity, as compared with conventional techniques. Although procedural success was lower in the RA group, there were no differences in long-term clinical outcomes between groups. {\circledC} 2016 Wiley Periodicals, Inc.",
author = "Lorenzo Azzalini and R Dautov and S Ojeda and A Serra and S Benincasa and B Bellini and Francesco Giannini and J Chavarr{\'i}a and LL Gheorghe and M Pan and M Carlino and A Colombo and S Rinfret",
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T1 - Long-term outcomes of rotational atherectomy for the percutaneous treatment of chronic total occlusions

AU - Azzalini, Lorenzo

AU - Dautov, R

AU - Ojeda, S

AU - Serra, A

AU - Benincasa, S

AU - Bellini, B

AU - Giannini, Francesco

AU - Chavarría, J

AU - Gheorghe, LL

AU - Pan, M

AU - Carlino, M

AU - Colombo, A

AU - Rinfret, S

PY - 2017

Y1 - 2017

N2 - Objectives. To study the long-term outcomes of rotational atherectomy (RA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background. There is little evidence on the incidence, procedural results and long-term outcomes of RA for CTO PCI. Methods. This registry included data from consecutive patients undergoing CTO PCI at four specialized centers. Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and ischemia-driven target-vessel revascularization) on follow-up were the primary endpoint. Results. A total of 1003 patients were included. Of these, 35 (3.5%) required RA. As compared with Conventional PCI, RA patients were older (68.9 ± 9.5 vs. 64.6 ± 10.7 years, P = 0.02), had higher prevalence of diabetes (58% vs. 37%, P = 0.01) and of a J-CTO score ≥2 (80% vs. 58%, P = 0.009), driven by severe calcification. Antegrade wire escalation was used more frequently in RA (74% vs. 53%, P = 0.08). RA was performed for balloon failure-to-cross in 51% and failure-to-expand in 49%. One burr was utilized in 86%. The 1.25-mm burr was the largest burr used in 43%. Slow flow/no-reflow was observed in 17%. No other serious RA-related complications were observed. Procedural success was 77% vs. 89% (P = 0.04) in RA vs. Conventional PCI. After a mean follow-up of 658 ± 412 days, MACE rates were similar between groups (15% vs. 13%, P = 0.70). Conclusions. The use of RA in CTO PCI was safe, despite a worse patient risk profile and higher procedural complexity, as compared with conventional techniques. Although procedural success was lower in the RA group, there were no differences in long-term clinical outcomes between groups. © 2016 Wiley Periodicals, Inc.

AB - Objectives. To study the long-term outcomes of rotational atherectomy (RA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background. There is little evidence on the incidence, procedural results and long-term outcomes of RA for CTO PCI. Methods. This registry included data from consecutive patients undergoing CTO PCI at four specialized centers. Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and ischemia-driven target-vessel revascularization) on follow-up were the primary endpoint. Results. A total of 1003 patients were included. Of these, 35 (3.5%) required RA. As compared with Conventional PCI, RA patients were older (68.9 ± 9.5 vs. 64.6 ± 10.7 years, P = 0.02), had higher prevalence of diabetes (58% vs. 37%, P = 0.01) and of a J-CTO score ≥2 (80% vs. 58%, P = 0.009), driven by severe calcification. Antegrade wire escalation was used more frequently in RA (74% vs. 53%, P = 0.08). RA was performed for balloon failure-to-cross in 51% and failure-to-expand in 49%. One burr was utilized in 86%. The 1.25-mm burr was the largest burr used in 43%. Slow flow/no-reflow was observed in 17%. No other serious RA-related complications were observed. Procedural success was 77% vs. 89% (P = 0.04) in RA vs. Conventional PCI. After a mean follow-up of 658 ± 412 days, MACE rates were similar between groups (15% vs. 13%, P = 0.70). Conclusions. The use of RA in CTO PCI was safe, despite a worse patient risk profile and higher procedural complexity, as compared with conventional techniques. Although procedural success was lower in the RA group, there were no differences in long-term clinical outcomes between groups. © 2016 Wiley Periodicals, Inc.

U2 - 10.1002/ccd.26829

DO - 10.1002/ccd.26829

M3 - Article

VL - 89

SP - 820

EP - 828

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

IS - 5

ER -