High-Speed Rotational Atherectomy in the Treatment of Bifurcation-Type Coronary Lesions

Abstract

Background: Bifurcational coronary lesions present a major interventional challenge. The differential cutting mechanism of high-speed rotational atherectomy (HSRA) may provide a favourable technique of treating this complex lesion subtype. Methods: We evaluated the use of HSRA (32 lesions) compared to balloon angioplasty (BA) (118 lesions), with provisional stenting in both groups, in a non-randomised, retrospective study of 150 bifurcation-type lesions. Results: The HSRA/stent group had a high primary success rate of 97%, an acceptably low in-hospital event rate of 9% and an overall major adverse cardiac event (MACE) rate at a mean follow-up period of 15 ± 3.4 months of 22.5% with a target lesion revascularisation (TLR) rate of 18.7%. Procedural success in the BA/stent group was 81% with an in-hospital event rate of 14.4%, and the overall MACE rate at follow-up was 27.5% with a TLR rate of 23%. We achieved a greater acute gain in minimal luminal diameter and a lesser percentage of residual stenosis after intervention in the HSRA/stent group compared to the BA/stent group (p < 0.01). Outcome at follow-up favoured the HSRA/stent group, although the difference did not reach statistical significance. Conclusion: HSRA with provisional stenting provided a safe and effective means of treating bifurcation lesions.

Feasibility and clinical outcomes of rotational atherectomy for heavily‐calcified side branches of complex coronary bifurcation lesions in the real‐world practice of the drug‐eluting stent era

“…SB preservation is a critical issue in the intervention of true bifurcation lesions. In the time of bare metal stent (BMS) and even in the era of early drug‐eluting stent (DES), SB RA is mainly used for debulking of large plaques, but not for heavy calcification . RA was first introduced two decades ago to treat bifurcation lesions with huge plaque burden in a “plaque debulking” manner rather than “plaque modification” for heavily calcified lesions as in the current study .…”

Evaluation of the Diamondback 360 Coronary Orbital Atherectomy System for treatingde novo, severely calcified lesions

“…We conducted a literature search to identify all published coronary Rotablator studies with clearly defined primary endpoints [42][43][44][45][46][47][48][49][50]. As presented in TABLE 1, the majority of the studies identified did not meet their primary endpoints.…”

Classification of coronary artery bifurcation lesions and treatments: Time for a consensus!

“…However, the combination of this classification with a number of wire, balloon, and atherectomy techniques accounts for all variants already reported or published [51][52][53]. We have decided to retain the initial denomination given to each individual technique, or, in the presence of several denominations, to select the most straightforward.…”