Morbidity and mortality in a cohort of individuals undergoing rotational atherectomy for extremely calcified lesions

Abstract

Background: The treatment of coronary arteries with heavily calcified or chronically occluded lesions has the lowest success rates when they undergo a percutaneous procedure. A strategy to reduce the volume of calcified lesions, which was part of the rescue technique to treat non-balloon dilatable stenoses, has evolved to an approach of primary lesion preparation for subsequent stenting. Methods: This is a retrospective analysis of data related to rotational atherectomies performed in complex, high-risk patients, for treating extremely calcified lesions with drug-eluting stent implantation, obtained from the Tasy Electronic Medical Record, between 2012 and 2016. Results: A cohort of 138 individuals was followed up after rotational atherectomy between 2012 and 2016. The most frequently observed risk factors were hypertension (87%), dyslipidemia (69%), diabetes mellitus (44%), and sedentary lifestyle (72%). A total of 244 vessels were treated, 179 of which with the aid of rotational atherectomy, and 308 drug-eluting stents were implanted. The SYNTAX II score was 22.4±11.5, with 18% of individuals classified as high risk (>33 points); femoral arterial access was employed in 76.8%. Lesion transposition was achieved in 98% of cases. Angiographic success was achieved with stenting in 98% of procedures. The length of hospital stay was 2.6±3.7 days. In-hospital mortality was 4%, and 4-year mortality was 14.5%. Long-term follow-up was performed by phone calls up to 4 years after the procedure. Ninety-seven percent of patients maintained regular use of dual antiplatelet therapy. Only 42% reported regular exercise. Angina pectoris was reported by 13% of individuals. Conclusion: Rotational atherectomy showed a low occurrence of adverse events in the immediate and late phases, leading to a high success rate of stent implantation in complex lesions.