Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics

Abstract

Rotational atherectomy (RA) has been widely used for percutaneous coronary intervention (PCI) to severely calcified lesions. As compared to other countries, RA in Japan has uniquely developed with the aid of greater usage of intravascular imaging devices such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT). IVUS has been used to understand the guidewire bias and to decide appropriate burr sizes during RA, whereas OCT can also provide the thickness of calcification. Owing to such abundant experiences, Japanese RA operators modified RA techniques and reported unique evidences regarding RA. The Task Force on Rotational Atherectomy of the J apanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document to summarize the contemporary techniques and evidences regarding RA.

Comparison of the incidence of periprocedural myocardial infarction between percutaneous coronary intervention with versus without rotational atherectomy using propensity score-matching

“…However, each PCI was strictly supervised by staff operator, and all PCI with RA were supervised by a senior staff operator (K. Sakakura). Our techniques regarding RA was almost consistent to those that were recommended by the clinical expert consensus document on RA from the Japanese association of cardiovascular intervention and therapeutics (CVIT) 2 . Staff operators did not hesitate to take over procedures, when residents felt any difficulties in procedures.…”

“…Rotational atherectomy (RA) is an essential procedure for the treatment of heavily calcified coronary lesions in percutaneous coronary intervention (PCI) 1 , 2 . However, the incidence of some complications, especially coronary perforation, is reported to be greater in PCI with RA than without 3 – 5 .…”

Modifiable and unmodifiable factors associated with slow flow following rotational atherectomy

“…Although the type of RotaWire (floppy or extra-support) was significantly associated with slow flow in the univariate analysis, the association between the type of RotaWire and slow flow was not significant in the multivariate analysis. Recently, the expert consensus document on RA including guidance for selection of RotaWires was published from the Japanese association of cardiovascular intervention and therapeutics [10]. Since the ability to ablate the severely calcified plaques is greater in extra-support than in floppy [10], we might use extra-support for more complex lesions, which may explain why extra-support was associated with slow flow in the univariate analysis, but was not in the multivariate analysis.…”

“…We did not distinguish between transient mild slow flow and severe permanent slow flow in the present study, because transient slow flow may be a warning sign for more severe complications. An expert consensus document also emphasizes the immediate management for TIMI-2 flow to prevent more severe slow flow [10].…”

“…Rotational atherectomy (RA) has been a reliable procedure for the treatment of severely calcified coronary lesions for more than 20 years [4,5]. However, unique complications such as slow flow, vessel perforation, and burr entrapment can occur during RA [6][7][8][9][10], which accounts for a greater incidence of severe outcomes after PCI with RA compared to that without RA [11]. Among complications in RA, slow flow is the most common [12].…”