Effects of technique modification on immediate results of high speed rotational atherectomy in 710 procedures on 656 patients

Abstract

Seven hundred ten high speed rotational atherectomy (HSRA) procedures were performed in a single consecutive series of 656 patients. Stand alone HSRA was performed in 253 patients (35%). HSRA with adjunctive low pressure (< or = 2 ATM) balloon angioplasty (LP BA) was performed in 221 patients (31%), and HSRA with adjunctive high pressure (> or = 4 ATM) balloon angioplasty (HP BA) was performed in 236 patients (34%). Prognostically unfavorable Type B2 and C lesions dominated the study group (74.7%). Procedural success rate was 96%. Emergency coronary artery bypass surgery was performed in 1.4% of cases, Q wave myocardial infarction occurred in 3.4% and death, related to procedure, was consequent in 0.5% of cases. Incidence of flow limiting dissections was 3.1%, distal spasm was 5.3%, and "no reflow" phenomenon was 1.8%. The recent technique modifications included continuous advancer/guiding catheter infusion of the nitroglycerin-verapamil mixture, limitation of duration of lesion engagement by the burr, stepwise increase in the burr size, decrease of rotational speed, and strict control of rpm drop during lesion ablation. Evolution of the interventional technique involved trends towards decrease of the use of HP BA in conjunction with steady increase in the percentage of SA and LP BA procedures over time. These technique changes resulted in complete absence of "no reflow" in 1994, as well as a generalized decrease in overall coronary vascular reactivity from all burr passes.

Acute and late clinical outcome after rotational atherectomy for complex coronary disease

“…Methods for improving rotablator technique to maximize favorable results and reduce complications have subsequently been reported [5,20,21,35,36]. Perhaps the most important modification in technique is careful avoidance of burr speed decrements in order to decrease heat generation and reduce the likelihood of embolization of atheroma that might result in myocardial injury, prolonged chest pain, and adverse outcome [5,21].…”

“…The ultimate success of rotational ablation depends on a number of factors including operator experience, appropriate technique, and lesion characteristics [5,13,20,21,35]. When the procedure is complicated by flow-limiting dissection, bail-out stenting is feasible and can reduce the incidence of major complications.…”

High‐speed rotational atherectomy and coronary stenting: QCA and QCU analysis

“…A 0.009Љ diameter, 300 cm stainless steel guidewire (Boston Scientific, Natick, MA) was placed distal to the lesion and rotational atherectomy was performed using various burr sizes (1.25-2.5 mm) chosen by the step-up technique [6]. In the HSRA group, rotational atherectomy was followed by adjunctive balloon angioplasty in 63% of patients.…”

Rotablation: Technik, Indikation, Ergebnisse

“…Mit Dissektionen ist in etwa 10% der F~ille zu rechnen [27,32,37]. In einer retrospektiven Analyse von 2303 behandelten Stenosen aus dem amerikanischen Register kam es bei einer Gesamth~iufigkeit fª Dissektionen von 12,8%, in 2,8% der F~ille zu einer fluBlimitierenden Dissektion.…”