Clinical predictors of mortality following rotational atherectomy and stent implantation in high‐risk patients: A single center experience

Abstract

ObjectivesOur aim was to assess the procedural success and determine the clinical predictors of postprocedure mortality, following rotational atherectomy (RA) and stenting in high‐risk patients.BackgroundRA is mainly used to facilitate stenting in complex lesions. Outcomes involving RA and stenting have been investigated, yet high‐risk patients have not been adequately described.MethodsData of 218 consecutive patients who underwent RA were evaluated in a prospective register. Primary endpoints were the angiographic success and long‐term mortality. Secondary endpoints were procedural success, consumption of the angioplasty equipment, and periprocedural major adverse cardiac events. The impact of the relevant angiographic and clinical characteristics on long‐term mortality was analyzed using uni‐ and multivariate Cox regression analysis.ResultsMean age of the patients was 70 ± 8.2 years, diabetes was present in 44%, and chronic renal failure in 29%. Prior myocardial infarction and three‐vessel disease amounted to 42.2% and 32.6%, respectively. Altogether, 52.8% of patients underwent RA after a failed, non‐RA intervention attempt, and 30.7% of cases presented as acute coronary syndromes. Angiographic success was 100%, and all patients received stents after RA. Periprocedural major adverse cardiac events occurred in five (2.3%) patients. Postprocedural death was investigated, with a mean follow‐up of 36 months. Mortality amounted to 37.2%. Multivariate analysis revealed that left ventricular ejection fraction < 50%, glomerular filtration rate < 60 ml/min, cardiogenic shock, and diabetes were the only independent mortality predictors.ConclusionsWe have found that RA and stenting is feasible and viable in an elderly high‐risk population, with exceptional procedural success and acceptable long‐term results. © 2015 Wiley Periodicals, Inc.

Difficult Stentablation with an Episode of Stuck and Entrapped Burr within the Underexpanded Stent

“…Several authors have reported that RA followed by stent implantation is a feasible method in terms of high rate of procedural success and favorable long-term outcomes in heavily calcified coronary lesions. [2][3][4][5][6] It is difficult to recognize underexpansion of the balloon and adequate lesion preparation before stenting. IVUS before stenting can help to avoid underexpansion of the stent without sufficient lesion preparation.…”

“…1) If there is a calcified lesion with insufficient expansion after ballooning with non-compliant balloons, rotational atherectomy (RA) is one of the available options for pretreatment of calcified plaques. [2][3][4][5][6] RA might also be used to remove an underexpanded stent. However, there are several problems associated with RA for removal of underexpanded stents.…”

Patients with acute myocardial infarction and severe target lesion calcifications undergoing percutaneous coronary intervention have poor long-term prognosis

“…The two affirmed as most effective in facilitating PCI in HCCL are (RA and recently introduced orbital atherectomy (OA). RA showed favourable results in treating HCCL in recent registries; however, there are no randomised trials concerning the use of RA in patients with severe TLC and AMI [20][21][22]. OA, a newcomer to coronary interventions, was first introduced in coronary arteries in 2013 in the ORBIT I trial [23].…”

“…This is in concordance with our experience, as only one patient included in the study underwent RA. Despite good results of patients with ACS treated with RA, this plaque modification technique is not applicable to all ACS patients, so we should strive for new solutions to improve the outcomes of all patients with ACS and severe TLC [20].…”

Buzzing the plaque: Coronary rotational atherectomy in its third decade

“…In support of the more frequent application of rotational atherectomy in high risk, no option patients, an article in this issue of CCI by Edes et al [2] describes the outcome after rotational atherectomy in a high-risk population [left main coronary artery (LM) in 20.2%, left ventricular ejection fraction (LVEF) < 50% in 37.6] of elderly patients (mean age 70 years) with complex, often heavily calcified lesions (83.1%) over half of which were unable to be opened by traditional methods. Despite the overall illness of the population, the procedure and in-hospital major adverse cardiac events (MACE) was amazingly low at 2.3%.…”