Rotational Atherectomy Complicated by Coronary Perforation Is Associated With Poor Outcomes: Analysis of 10,980 Cases From the British Cardiovascular Intervention Society Database

Protty, Majd; Hussain, Hussain I.; Gallagher, Sean; Al-Raisi, Sara; Aldalati, Omar; Farooq, Vasim; Sharp, Andrew; Anderson, Richard; Kinnaird, Tim

doi:10.1016/j.carrev.2020.07.040

Cited by 12 publications

(5 citation statements)

References 12 publications

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“…Contrary to the report of other authors, we did not observe higher periprocedural complication rates upon an upfront futile attempt of PCI in unplanned RA procedures [ 9 , 10 , 13 ]. Coronary perforations in both groups were in the range of previously published prospective data [ 7 , 16 ]. As previously shown by others [ 9 – 13 ], the use of contrast volume, fluoroscopy time and radiation exposure were significantly higher in the unplanned group.…”

Section: Discussionsupporting

confidence: 72%

Planned versus unplanned rotational atherectomy for plaque modification in severely calcified coronary lesions

et al. 2023

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Background Evidence on the optimal timing of RA is scarce, although increased periprocedural complications for unplanned procedures have been reported. Aims To compare planned versus unplanned use of rotational atherectomy (RA) for plaque modification in patients with severely calcified coronary lesions. Methods Procedural and 1-year follow-up data of planned (n = 562 lesions in 448 vessels of 416 patients) and unplanned (n = 490 lesions in 435 vessels of 403 patients) RA between 2008 and 2020 were analyzed using the propensity score methods. The primary composite endpoint was target lesion failure (TLF), defined as cardiovascular death (CVD), target vessel myocardial infarction (TVMI), or target lesion revascularization (TLR). Results Angiographic success was > 99% in both groups. Fluoroscopy time and contrast volume were significantly lower in planned RA (p < 0.001). Periprocedural complications including slow-flow, coronary dissection, and MI occurred in 4.8% after planned, and in 5.7% after unplanned RA. TLF occurred in 18.5% after planned, and in 14.7% after unplanned RA. Weighted subdistribution hazard ratios for TLFs revealed an unfavorable 1-year outcome for planned RA (sHR 1.62 [1.07–2.45], p = 0.023), which was driven by TLR (sHR 2.01 [1.18–3.46], p = 0.011), but not by CVD, or TVMI. No differences were observed in all-cause mortality. Conclusions Unplanned RA was associated with favorable outcome when compared to planned RA. Thus, RA can safely be reserved for lesions that prove untreatable by conventional means. Randomized and prospective trials are needed to evaluate a predominant use of rotational atherectomy as a bailout strategy in the future. Graphical abstract

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Section: Discussionsupporting

confidence: 72%

Planned versus unplanned rotational atherectomy for plaque modification in severely calcified coronary lesions

et al. 2023

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“…22 In the report from the British Cardiac Intervention Society Database comprising 10,980 rotational atherectomy PCIs from 2007 to 2014, CAP in rotational atherectomy PCI was rare but significantly higher than for all PCIs (1.52% vs. 0.4%, respectively). 5, 23 In a report involving 56 Ellis Grade III CAPs among 24,465 PCI patients, rotational atherectomy was one of the predictors for CAP (odds ratio 3.47; P=0.002). 14 The use of rotational atherectomy has increased in the contemporary PCI era.…”

Section: Discussionmentioning

confidence: 99%

Intra- and Postprocedural Management of Coronary Artery Perforation During Percutaneous Coronary Intervention

et al. 2022

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Background: Little is known regarding the postprocedural management of coronary artery perforation (CAP). Methods and Results:The characteristics, outcomes, and management of 115 CAP cases among 13,453 patients undergoing percutaneous coronary intervention (PCI) between 2001 and 2017 at Miyazaki Medical Association Hospital were analyzed retrospectively. The incidence of CAP was 0.85% (25 [0.19%] coronary ruptures [CRs], 90 [0.67%] wire perforations [WPs]). The most prevalent causes of CRs and WPs were rotational atherectomy (36.0%) and polymer-jacketed wires (41.1%), respectively. Fifty-two percent of CRs were treated using prolonged balloon inflation, whereas 50% of WPs were treated through embolization. Immediate and delayed cardiac tamponade (CT) occurred in 20% and 24% of CRs, respectively, and in 2.2% and 10% of WPs, respectively. The mean (±SD) right atrial pressure (RAP) during delayed CT in the CR and WP groups was 16.0±1.2 and 14.0±3.0 mmHg, respectively. New-onset atrial fibrillation developed in 24.0% and 11.1% of patients in the CR and WP groups, respectively, whereas lateonset coronary artery aneurysm (CAA) occurred in 24.0% and 0% of patients, respectively. One-year mortality rates in patients with immediate and delayed CT were 28.6% and 20.0%, respectively.Conclusions: Special attention should be paid to delayed CT, new-onset atrial fibrillation, and late-onset CAA after CAP treatment. Continuous monitoring of RAP after CAP during PCI may be useful for the early detection of delayed CT.

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“…Coronary perforation due to the burr is the most serious complication in RA, and the incidence of perforation in RA is approximately 1-2% [98][99][100][101]. If coronary perforation occurs during RA, there would be a considerable risk of in-hospital death, especially the lesions involving left main coronary artery [102].…”

Section: Complications: Perforation/rupturementioning

confidence: 99%

Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023

Sakakura

Ito

Shibata³

et al. 2023

Cardiovasc Interv and Ther

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The Task Force on Rotational Atherectomy of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed the expert consensus document to summarize the techniques and evidences regarding rotational atherectomy (RA) in 2020. Because the revascularization strategy to severely calcified lesions is the hottest topic in contemporary percutaneous coronary intervention (PCI), many evidences related to RA have been published since 2020. Latest advancements have been incorporated in this updated expert consensus document.

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Rotational Atherectomy Complicated by Coronary Perforation Is Associated With Poor Outcomes: Analysis of 10,980 Cases From the British Cardiovascular Intervention Society Database

Cited by 12 publications

References 12 publications

Planned versus unplanned rotational atherectomy for plaque modification in severely calcified coronary lesions

Planned versus unplanned rotational atherectomy for plaque modification in severely calcified coronary lesions

Intra- and Postprocedural Management of Coronary Artery Perforation During Percutaneous Coronary Intervention

Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023

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