Rotational atherectomy to enable sirolimus-eluting stent implantation in calcified, nondilatable de novo coronary artery lesions: Mid-term clinical and angiographic outcomes

Michael Schlüter, John Cosgrave, Thilo Tübler, Gloria Melzi, Antonio Colombo, Joachim Schofer

Research output: Contribution to journalArticle

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Abstract

Objectives. Our goal was to assess the mid-term clinical and angiographic efficacy of rotational atherectomy preceding sirolimus-eluting stent (SES) implantation. Background. Nondilatable calcified coronary lesions have been excluded from all clinical trials involving the SES. The clinical and angiographic efficacy of rotational atherectomy to enable SES implantation is not known. Methods. We performed rotational atherectomy to enable SES implantation in 44 consecutive patients (34 men; mean [± 1 SD] age 67 ± 9 years). They presented with a total of 47 nondilatable lesions (mean length 22.7 ± 13.7 mm). Results. Rotational atherectomy enabled SES implantation in all cases. The cumulative incidences of target lesion revascularizations and major adverse cardiac events at 7.7 ± 3.0 months were 9.1% (4 patients; 95% confidence interval [CI], 2.5-21.7%) and 11.4% (5 patients; 95% CI, 3.8 24.6%), respectively. Angiographic follow-up obtained from 29 patients (31 lesions) at 7.0 ± 2.8 months revealed a median late loss in-stent of 0.31 mm and in-segment of 0.22 mm. Binary restenosis was observed in-stent in 3 lesions (9.7%; 95% CI, 2.0-25.8%) and at the stent margins in another 3 lesions (in-segment restenosis 19.4%; 95% CI, 7.5-37.5%). Conclusions. It is concluded that rotational atherectomy to enable SES implantation in long, nondilatable calcified coronary lesions is feasible and safe, with acceptable mid-term efficacy.

Original languageEnglish
Pages (from-to)63-69
Number of pages7
JournalVascular Disease Management
Volume4
Issue number3
Publication statusPublished - May 2007

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Coronary Atherectomy
Sirolimus
Stents
Coronary Vessels
Confidence Intervals
Clinical Trials

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Rotational atherectomy to enable sirolimus-eluting stent implantation in calcified, nondilatable de novo coronary artery lesions : Mid-term clinical and angiographic outcomes. / Schlüter, Michael; Cosgrave, John; Tübler, Thilo; Melzi, Gloria; Colombo, Antonio; Schofer, Joachim.

In: Vascular Disease Management, Vol. 4, No. 3, 05.2007, p. 63-69.

Research output: Contribution to journalArticle

Schlüter, Michael ; Cosgrave, John ; Tübler, Thilo ; Melzi, Gloria ; Colombo, Antonio ; Schofer, Joachim. / Rotational atherectomy to enable sirolimus-eluting stent implantation in calcified, nondilatable de novo coronary artery lesions : Mid-term clinical and angiographic outcomes. In: Vascular Disease Management. 2007 ; Vol. 4, No. 3. pp. 63-69.
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abstract = "Objectives. Our goal was to assess the mid-term clinical and angiographic efficacy of rotational atherectomy preceding sirolimus-eluting stent (SES) implantation. Background. Nondilatable calcified coronary lesions have been excluded from all clinical trials involving the SES. The clinical and angiographic efficacy of rotational atherectomy to enable SES implantation is not known. Methods. We performed rotational atherectomy to enable SES implantation in 44 consecutive patients (34 men; mean [± 1 SD] age 67 ± 9 years). They presented with a total of 47 nondilatable lesions (mean length 22.7 ± 13.7 mm). Results. Rotational atherectomy enabled SES implantation in all cases. The cumulative incidences of target lesion revascularizations and major adverse cardiac events at 7.7 ± 3.0 months were 9.1{\%} (4 patients; 95{\%} confidence interval [CI], 2.5-21.7{\%}) and 11.4{\%} (5 patients; 95{\%} CI, 3.8 24.6{\%}), respectively. Angiographic follow-up obtained from 29 patients (31 lesions) at 7.0 ± 2.8 months revealed a median late loss in-stent of 0.31 mm and in-segment of 0.22 mm. Binary restenosis was observed in-stent in 3 lesions (9.7{\%}; 95{\%} CI, 2.0-25.8{\%}) and at the stent margins in another 3 lesions (in-segment restenosis 19.4{\%}; 95{\%} CI, 7.5-37.5{\%}). Conclusions. It is concluded that rotational atherectomy to enable SES implantation in long, nondilatable calcified coronary lesions is feasible and safe, with acceptable mid-term efficacy.",
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N2 - Objectives. Our goal was to assess the mid-term clinical and angiographic efficacy of rotational atherectomy preceding sirolimus-eluting stent (SES) implantation. Background. Nondilatable calcified coronary lesions have been excluded from all clinical trials involving the SES. The clinical and angiographic efficacy of rotational atherectomy to enable SES implantation is not known. Methods. We performed rotational atherectomy to enable SES implantation in 44 consecutive patients (34 men; mean [± 1 SD] age 67 ± 9 years). They presented with a total of 47 nondilatable lesions (mean length 22.7 ± 13.7 mm). Results. Rotational atherectomy enabled SES implantation in all cases. The cumulative incidences of target lesion revascularizations and major adverse cardiac events at 7.7 ± 3.0 months were 9.1% (4 patients; 95% confidence interval [CI], 2.5-21.7%) and 11.4% (5 patients; 95% CI, 3.8 24.6%), respectively. Angiographic follow-up obtained from 29 patients (31 lesions) at 7.0 ± 2.8 months revealed a median late loss in-stent of 0.31 mm and in-segment of 0.22 mm. Binary restenosis was observed in-stent in 3 lesions (9.7%; 95% CI, 2.0-25.8%) and at the stent margins in another 3 lesions (in-segment restenosis 19.4%; 95% CI, 7.5-37.5%). Conclusions. It is concluded that rotational atherectomy to enable SES implantation in long, nondilatable calcified coronary lesions is feasible and safe, with acceptable mid-term efficacy.

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