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

Abstract

To evaluate the acute effect of pretreatment with high-speed rotational atherectomy (HSRA) on stent deployment (rotastenting), we studied 33 patients with rotastenting of 40 segments, 34 patients with 40 coronary segments treated with Palmaz-Schatz stenting alone, and 34 patients with 40 segments treated with HSRA. The HSRA- and stent-alone patient groups were selected retrospectively by matching the quantitative coronary angiography (QCA) reference diameter (D ref). QCA revealed similar baseline percent of stenosis (85.3% +/- 12.4%), minimal luminal diameter (MLD), and D ref. The percent area expansion was calculated as a ratio between the minimal intrastent area and the reference area measured by intracoronary ultrasound. The rotastent group was characterized by more frequent calcification compared to HSRA and stent groups (67.5% vs. 20% and 12.5%; P < 0.01). Lesion length determined by QCA was longer both in the HSRA and the rotastent groups vs. the stent-alone group (21.1 +/- 12.3 and 20.9 +/- 4.3 vs. 17.0 +/- 7.7 mm; P < 0.05). In this small study, there was no difference demonstrated between final MLD in the rotastent and stent-alone groups. However, a smaller MLD was achieved in the HSRA group (3.0 +/- 0.7 vs. 3.1 +/- 0.5 vs. 2.5 +/- 0.7 mm, respectively; P < 0.01). The degree of stent expansion was higher in the rotastent group compared to the stent-alone group (91.9% +/- 4.4% vs. 79.7% +/- 3.4%; P < 0.03) and the % residual area of plaque was less for the rotastent group than for the stent-alone group (12.1% +/- 13.2% vs. 21.1% +/- 17.5%; P = 0.03). These data suggest that antecedent HSRA atheroma debulking using HSRA results in improved intravascular stent expansion and reduction in residual plaque, facilitating optimal stent deployment.

An evidence‐based approach to the use of rotational and directional coronary atherectomy in the era of drug‐eluting stents: When does it make sense?

“…RA improves arterial compliance allowing for the passage of equipment and more uniform and symmetric stent deployment [54]. In addition, RA increases the MLD postprocedure with minimal deep vessel injury and decreases residual plaque which may decrease the risk of ISR [55]. Of note, aggressive RA (defined as burr size >2.25 mm or burr/artery diameter ratio >0.8) has been shown to increase periprocedural myocardial infarctions [56] and should be avoided.…”

Rotational atherectomy for fibro‐calcific coronary artery disease in drug eluting stent era: Procedural outcomes and angiographic follow‐up results

“…Rotational atherectomy improves arterial compliance allowing for the passage of equipment and more uniform and symmetric stent deployment [35]. RA also increases the MLD post procedure with minimal vessel injury and decreases the residual plaque, which may potentially reduce the risk of restenosis [36]. Rotational atherectomy has shown high procedural success rates with uncrossable and nondilatable lesions [37][38][39].…”

Real‐World Multicenter Registry of Patients with Severe Coronary Artery Calcification Undergoing Orbital Atherectomy

“…Rotational atherectomy, which was first introduced in the early 1990s, modifies severely calcified plaque, thereby facilitating stent delivery and expansion . Orbital atherectomy represents the first coronary atherectomy device in over 20 years to ablate severe CAC.…”