Planned versus provisional rotational atherectomy for severe calcified coronary lesions: Insights From the ROTATE multi-center registry

Hiroyoshi Kawamoto, Azeem Latib, Neil Ruparelia, Giacomo G. Boccuzzi, Mauro Pennacchi, Gennaro Sardella, Roberto Garbo, Emanuele Meliga, Fabrizio D'Ascenzo, Claudio Moretti, Marco Luciano Rossi, Patrizia Presbitero, Alfonso Ielasi, Caroline Magri, Sunao Nakamura, Antonio Colombo

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Abstract

Objectives: We aimed to investigate procedural feasibility and outcomes associated with planned rotational atherectomy (RA) for severely calcified coronary lesions. Background: Limited data are available addressing the benefits of planned RA compared to provisional RA. Methods: Between 2002 and 2013, all patients with calcified lesions treated by RA were enrolled. Of these, patients treated with planned RA (358 patients) were compared to those treated with provisional RA (309 patients). Results: In-hospital major adverse cardiovascular events (MACE) were tended to be better in the planned RA group (unadjusted OR: 0.76; 95% CI: 0.44–1.31, P = 0.32, and adjusted OR: 0.59; 95% CI: 0.33–1.05, P = 0.07). The number of pre-dilation balloon catheters was significantly lower in the planned RA group (1.17 ± 0.60 vs. 1.47 ± 0.76, P <0.001). Procedure time, fluoroscopy time, and contrast volume used were all significantly reduced in the planned RA group compared to the provisional RA group (procedure time; 65.2 ± 36.8min vs. 84.4 ± 43.1min, P <0.001, fluoroscopy time; 33.1 ± 22.9min vs. 51.2 ± 29.6min, P <0.001, and contrast volume; 232.9 ± 141.6ml vs. 302.9 ± 150.3ml, P <0.001). The incidence of MACE at 1-year was significantly higher amongst the unadjusted population, whereas the difference was less marked between groups after propensity-score adjustment (unadjusted HR: 1.78; 95% CI: 1.16–2.74, P = 0.01, and adjusted HR: 1.44; 95% CI: 0.92–2.26, P = 0.11). Conclusions: Planned RA appears to be safe and was associated with a reduction in procedural and fluoroscopy times, contrast volume, and the number of pre-dilation balloon catheters used. If there is a strong likelihood of requiring RA for the treatment of severely calcified lesions, operators should have a low threshold for adopting a planned RA strategy. © 2016 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)881 - 889
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume88
Issue number6
DOIs
Publication statusPublished - Nov 15 2016

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Keywords

  • calcified lesions
  • percutaneous coronary intervention
  • rotational atherectomy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Kawamoto, H., Latib, A., Ruparelia, N., Boccuzzi, G. G., Pennacchi, M., Sardella, G., Garbo, R., Meliga, E., D'Ascenzo, F., Moretti, C., Rossi, M. L., Presbitero, P., Ielasi, A., Magri, C., Nakamura, S., & Colombo, A. (2016). Planned versus provisional rotational atherectomy for severe calcified coronary lesions: Insights From the ROTATE multi-center registry. Catheterization and Cardiovascular Interventions, 88(6), 881 - 889. https://doi.org/10.1002/ccd.26411