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

Rathore, Sudhir; Matsuo, Hitoshi; Terashima, Mitsuyasu; Kinoshita, Yoshihisa; Kimura, Masashi; Tsuchikane, Etsuo; Nasu, Kenya; Ehara, Mariko; Asakura, Yasushi; Katoh, Osamu; Suzuki, Takahiko

doi:10.1002/ccd.22437

Cited by 113 publications

(91 citation statements)

References 46 publications

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“…On the other hand, we have also proven that long‐term FU of our high‐risk, elderly RA stented patients yield acceptable all‐cause mortality data as compared with that in other databases 1, 2, 3, 4, 5, 6.…”

Section: Discussionmentioning

confidence: 51%

“…Rathore et al 5 compared the restenosis, success rate, and the in‐hospital outcomes after RA with BMS versus DES implantations and have found significantly better restenosis rates following DES implantation (11% vs. 28.1%, P < 0.001). Benezet et al 1 published total cardiac death, target lesion revascularization, and MI incidence rates of up to 4.9%, 3.9%, and 8.8%, respectively, at 15 months FU with RA stenting using DES devices.…”

Section: Discussionmentioning

confidence: 99%

“…Rotational atherectomy (RA) has emerged as a method of solving such coronary lesions, but is mainly available in tertiary, high‐volume centers. RA with subsequent bare metal stent (BMS) or drug‐eluting stent (DES) implantation improves the clinical outcomes of patients with calcified coronary artery disease (CAD) 1, 2, 3, 4, 5, 6, 7, 8 and procedure‐related major adverse cardiac events (MACE) along with mid‐ to long‐term mortality have all been at acceptable levels. Nonetheless, RA is still a technically demanding method requiring scrupulous execution, which may explain why it is seldom used in everyday interventional practice 9, 10, 11.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, in the available databases, mainly low‐ or moderate‐risk subjects have been investigated 1, 2, 3, 4, 5, 6, 7, 8. Data regarding the survival after RA stenting in high‐risk patients with diffuse CAD presenting with extensive co‐morbidities have not yet been sufficiently investigated.…”

Section: Introductionmentioning

confidence: 99%

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

Édes

Ruzsa

Szabó

et al. 2015

Cathet Cardio Intervent

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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.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Édes

Ruzsa

Szabó

et al. 2015

Cathet Cardio Intervent

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“…Recently published intermediate and long-term outcomes after PCI and DES with adjunctive RA report rates of target lesion revascularisation (TLR) < 10% within one to two years [6]. In patients treated with RA, rates of MACE are lower with DES stenting compared with bare-metal stent (BMS) stenting [6,7]. However, the ROTAXUS study did not demonstrate the advantage of RA with DES implantation over angioplasty with DES alone [8].…”

Section: Next Year Will Mark the 30mentioning

confidence: 99%

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

Bartuś¹,

Januszek

Legutko³

et al. 2017

Kardiol Pol

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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.

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Percutaneous transluminal rotational atherectomy for coronary artery disease

Wasiak

Law

Watson

et al. 2012

Cochrane Database of Systematic Reviews

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

Abstract: Rotational atherectomy can be performed with high success rates and low complications, and rotational atherectomy followed by drug eluting stent implantation significantly reduces binary restenosis rates in fibrocalcific lesions as compared to rotational atherectomy and bare metal stents.

Cited by 113 publications

References 46 publications

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

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

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

Percutaneous transluminal rotational atherectomy for coronary artery disease

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