Procedural and In-hospital Outcomes of Rotational Atherectomy in Retrograde Coronary Chronic Total Occlusion Intervention

Xu, Ran; Song, Xiaoyue; Chang, Shufu; Qin, Qing; Li, Chenguang; Fu, Mingqiang; Ren, Daoyuan; Ge, Liang; Qian, Juying; Ma, Jianying

doi:10.1177/0003319720949312

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…The percentage of RA for chronic total occlusion (CTO) ranged from 9.1 to 25%. The CTO subgroup has been investigated in our previous study 18 . Nearly 90% cases were multi‐vessel diseased and about one third received intervention of non‐RA vessel.…”

Section: Resultsmentioning

confidence: 99%

Outcomes of rotational atherectomy for severely calcified coronary lesions: A single center 5‐year experience

Gao

Chen

Yang

et al. 2021

Cathet Cardio Intervent

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Objectives The aim of this study was to investigate the influences of accumulated experience on rotational atherectomy (RA) operation regarding to in‐hospital outcomes in the drug‐eluting stent (DES) era. Methods Between 2015 and 2019, 540 de novo lesions with calcified coronary lesions treated by RA and DES implantation at our center were retrospectively assessed. In‐hospital major adverse cardiac events (MACE) were defined as all cause death, cardiac death, target vessel revascularization, and stroke. Results From 2015 to 2019, RA operations were 22, 60, 102, 157, and 199 cases, respectively. Rates of procedural complications were 4.5, 3.3, 11.8, 8.3, and 7.5%, respectively. Rates of in‐hospital MACE were 0, 0, 3.9, 2.5, and 2.0%, respectively. Compared with planned RA, bailout RA was associated with more contrast use (207.5 ± 82.8 ml vs. 189.2 ± 70.0 ml, p = .008). As for procedural complications and in‐hospital outcomes, no differences were observed between two strategies. Logistic regression revealed that hypertension was independently associated with complications (OR 5.830, 95% CI 1.382–24.591, p = .016). For MACE, independent risk factors were heart failure (OR 17.593, 95% CI 1.475–209.816, p = .023) and procedural complications (OR 127.629, 95% CI 15.135–1,076.258, p < .001). Conclusions Along with the rapid increase of RA use and accumulated experience, rates of complications and MACE went up first and then dropped down. Hypertension was found to be an independent risk factor of procedural complications. For in‐hospital MACE, independent risk factors were heart failure and procedural complications.

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Section: Resultsmentioning

confidence: 99%

Outcomes of rotational atherectomy for severely calcified coronary lesions: A single center 5‐year experience

Gao

Chen

Yang

et al. 2021

Cathet Cardio Intervent

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“…Similar to our study, a single-center study in Germany that enrolled CTO (n = 75) and non-CTO (n = 317) PCI patients who had RA prior to stent implantation found no differences in in-hospital MACCE rates despite the occurrence of significantly more dissections when RA was employed (8). In an in-hospital cohort of 129 patients undergoing CTO-PCI with RA reported a higher incidence of dissection in the retrograde arm compared with the antegrade approach (25).…”

Section: Discussionmentioning

confidence: 61%

Safety and Feasibility of Rotational Atherectomy for Retrograde Recanalization of Chronically Occluded Coronary Arteries

Wang

Huang

Yakubu

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveTo evaluate the safety and feasibility of rotational atherectomy (RA) in retrograde chronic total occlusion percutaneous coronary intervention (CTO-PCI) by analyzing immediate and long-term outcomes.BackgroundRecent evidence supports the safety and feasibility of RA in CTO-PCI. However, few studies have focused on the use of RA in a retrograde approach to percutaneous revascularization of chronic total occlusion (CTO) lesions and information on long-term outcomes is lacking.MethodsA total of 329 patients who underwent retrograde CTO-PCI, out of 1496 consecutive CTO-PCI patients from April 2017 to July 2020, were retrospectively recruited from the 2nd Cardiology Department of the Guangdong Provincial People's Hospital. 16 patients underwent RA (RA group) whilst 313 did not (non-RA group).ResultsTechnical (87.5% vs. 87.5) and procedural (85.9% vs. 87.5) success rates were similar between both groups. There was no difference concerning major procedural complications between groups (12.5% vs. 19.2%; p > 0.75). No in-hospital MACCEs was recorded in the RA group while there were eight MACCEs in the non-RA group (p > 0.99). In the RA group, 2 cases recorded perforation (1 target vessel perforation case and 1 branch vessel perforation), and 55 cases of vessel perforations/dissections were recorded in non-RA group including 18 target vessel perforations, 2 branch vessel perforations, 35 collateral vessel perforations (one patient died from cardiac tamponade). No difference was found in terms of the perforation rate between the two groups (p > 0.99). Over a mean follow-up period of 26.47 ± 14.46 months, use of RA in retrograde CTO-PCI did not result in an increased mortality rate [hazard ratio (HR) 1.58, 95% confidence interval (CI), 0.31–8.21, p = 0.65], major adverse cardiac and cerebral events (HR 0.99, 95% CI 0.35–2.79, p = 0.99) or overall rehospitalization rate (HR 1.27, 95% CI 0.44–3.67, p = 0.67). Adjusted Kaplan–Meier curves according to Cox regression model suggested several predictors influencing the all-cause mortality, cardiovascular mortality, MACCEs, stroke rate, non-fatal myocardial infarction, target vessel recanalization rate and rehospitalization rate in the comparison.ConclusionsOur study demonstrates that the in-hospital outcomes and long-term follow up events were the same between RA and non-RA retrograde CTO-PCI patients. RA offered an option for skillful operators in difficult cases when the lesion was severely calcified in retrograde CTO-PCI.

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“…In our previous studies, we have identified age, diabetes, renal insufficiency, ACS, cardiogenic shock, and residual Syntax score as prognostic factors for short and intermediate outcomes (16,17). Despite several studies having reported on the feasibility of rotablation for CTO lesions (4,(18)(19)(20)(21)(22)(23)(24)(25), only two of them compared RA for CTO vs. RA for non-CTO lesions (26,27). For the studies that compared RA for CTO with non-CTO lesions, none of them was analyzed after correcting for confounding factors.…”

Section: Introductionmentioning

confidence: 99%

Rotational atherectomy for chronically and totally occluded coronary lesions: A propensity score-matched outcomes study

Tsai

Chen

et al. 2022

Front. Cardiovasc. Med.

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BackgroundDespite advances being made in techniques and devices, certain chronic total occlusion (CTO) lesions remain uncrossable or undilatable. Rotational atherectomy (RA) is usually necessary for such lesions to achieve successful revascularization.MethodsInformation regarding consecutive patients who underwent coronary RA was retrieved from the catheterization laboratory database. Patients who underwent RA for CTO lesion refractory using other conventional devices were recruited, with propensity score-matched cases serving as controls.ResultsA total of 411 patients underwent coronary RA in the study period. Most patients had high-risk features (65.7% had acute coronary syndrome (ACS), 14.1% ischemic cardiomyopathy, and 5.1% cardiogenic shock), while only 20.2% of the patients had stable angina. Among them, 44 patients underwent RA for CTO lesions (CTO group), whereas the propensity score matched controls consist of 37 patients (non-CTO group). The baseline characteristics, high-risk features, coronary artery disease (CAD) vessel numbers, left ventricular function and biochemistry profiles of both groups were the same except for more patients with diabetes (67.6% vs. 45.5%, p = 0.046) in the non-CTO group and more 1.25 mm burr uses in the CTO group. There were no significant differences in acute procedural outcomes or incidence of acute contrast-induced nephropathy (CIN), and no patient demanded emergent CABG or died during the procedure. There was no significant difference in major adverse cardiovascular events (MACE), CV MACE or individual components between the two groups in the hospital, at 30, 90, and 180 days or at 1 year.ConclusionIn comparison with the propensity risk factor scores-matched controls, there was no difference in procedural complications, acute CIN or clinical outcomes during various stages of RA for CTO lesions. RA for CTO patients was highly efficient and showed safety and outcome profiles similar to those for non-CTO lesions.

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Procedural and In-hospital Outcomes of Rotational Atherectomy in Retrograde Coronary Chronic Total Occlusion Intervention

Cited by 4 publications

References 25 publications

Outcomes of rotational atherectomy for severely calcified coronary lesions: A single center 5‐year experience

Outcomes of rotational atherectomy for severely calcified coronary lesions: A single center 5‐year experience

Safety and Feasibility of Rotational Atherectomy for Retrograde Recanalization of Chronically Occluded Coronary Arteries

Rotational atherectomy for chronically and totally occluded coronary lesions: A propensity score-matched outcomes study

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