Long-term effects of rotational atherectomy in patients with heavy calcified coronary artery lesions: a single-centre experience

Abstract

A b s t r a c tBackground: Rotational atherectomy (RA) plays a significant role in contemporary percutaneous coronary interventions (PCI), especially in the era of population aging and expansion of PCI indications. Aim:The aim of the current study was to evaluate the rate of periprocedural complications, the long-term effectiveness of RA, and potential factors influencing the incidence of major adverse cardiac events (MACE) and major cardiac as well as cerebrovascular events (MACCE) after RA. Methods:The study included 60 consecutive patients who underwent effective RA between January 2002 and May 2016. Patients were followed-up for 2,616 days for MACE and MACCE. Results:The mean age of the enrolled patients was 72.1 years, and 78.3% were males. The mean follow-up period lasted 835.3 ± 611.8 days. Periprocedural complications occurred in 12 (20.0%) patients. In the follow-up of up to 2,616 days, 64% of patients were free of MACCE and 68% were free of MACE. Univariate Cox analysis revealed that MACCE occurred more often in patients from the high-risk group based on the EuroSCORE II and those with longer lengths of the implanted stent(s) after the RA procedure. In multivariate Cox regression analysis, both high-risk category and mean stent(s) length were identified as independent predictors of MACCE. EuroSCORE II was confirmed to be the only independent predictor of MACE after RA. Conclusions:Rotational atherectomy is a safe and sufficient technique for the endovascular treatment of heavily calcified coronary artery lesions. Individuals at a higher risk as assessed by the EuroSCORE II before RA and those with longer stent(s) implanted after RA are predisposed to MACCE in the follow-up.

Age and gender differences in clinical outcomes of patients with heavy-calcified coronary artery lesions treated percutaneously with rotational atherectomy

“…The relationship between the EUROSCORE II value and the length of the implanted stent was demonstrated in a previously published paper. 15 The level of perforations in the presented study was higher (3.1%) when compared to the published results based on large registries (0.3-1.1%). 16,17 However, coronary perforations observed in our analysis were not complicated by serious and life-threatening incidents, including cardiac tamponade and surgical treatment.…”

“…One of the factors that could have an impact on the incidence of MACCE in this study was higher mean length and diameter of stents in men compared to women, which was shown to be related to the incidence of MACCE in the follow-up period in other studies, including those published by our center. 15 On the other hand, in this study, the men were statistically significantly younger and less likely to have hypertension and hypercholesterolemia. Men were also insignificantly younger in our study, which certainly influenced the results.…”

Acute coronary syndrome – Still a valid contraindication to perform rotational atherectomy? Early and one-year outcomes

“…Nonetheless, in one single center RA registry high Euroscore II and in one multicenter registry SS ! 23 had a significant association with MACE in long-term observation [17,24]. Additionally, a couple of other predictors of poor outcome after RA were observed in the literature in particular studies, such as chronic kidney disease and dialysis, diabetes mellitus, peripheral vascular disease, the use of drug-eluting stents (versus bare metal stents) [16,17,19].…”

“…Coronary anatomy in patients with ACS was reflected by higher SS [21 (15-29) vs. 17 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), p = 0.02] with concomitant higher residual SS [10 (1-18) vs. 7 (0-12), p = 0.04]. Patients in ACS group were also more frequently disqualified from CABG (54% vs. 32%, p = 0.01), because of high operative risk.…”

Current perspectives on the role of bioresorbable scaffolds in the management of coronary artery disease

“…Apart from patient selection, proper lesion selection and preparation seems crucial to achieve optimal results of BRS implantation. According to the ESC-EAPCI Task Force document, the use of BRS is strongly discouraged in heavily calcified vessels [12,66]. Also, its use is not recommended in coronary arteries with RVD < 2.5 mm.…”