Rotablation in the Drug Eluting Era: Immediate and Long‐Term Results from a Single Center Experience

Abstract

The aim of this study was to investigate the immediate and long-term outcome of patients who were treated with rotational atherectomy (RA) to facilitate the delivery of drug eluting stents (DES) in heavily calcified lesions. We analyzed 150 consecutive patients who underwent RA and subsequently DES implantation in our institution. The patients had heavily calcified coronary artery lesions requiring plaque modification prior to conventional angioplasty and stent implantation. Rotational atherectomy was performed using the standard Boston Scientific Rotablator system. A 2-burr stepped approach was selected in most of the cases. Following successful modification of the plaque, the angioplasty was performed with a balloon at low pressure to avoid dissection and a DES was implanted. The mean follow up period was 3 years (max. 78 months). Follow-up data included all cause death, stroke, myocardial infarction (MI), recurrent angina, re-hospitalization, target lesion revascularization (TLR), target vessel revascularization (TVR), and long-term duration of dual antiplatelet therapy. The rate of recurrent angina and MI during follow up was low (3.3%) and the overall major adverse cardiac events (MACE) rate was 11.3%. No MACE occurred during hospitalization. There was no relationship between discontinuation of clopidogrel and occurrence of death or MI. The combined approach of RA-DES has a favorable effect when dealing with heavily calcified lesions in both the angiographic and clinical outcomes. No safety concerns are observed up to 6 years.

Comparison of Long-Term Clinical Outcomes Between Sirolimus-Eluting Stents and Paclitaxel-Eluting Stents Following Rotational Atherectomy

“…In these studies, multiple classes of DES were used, however, they did not analyze the differences among the classes. 16,17) The present study investigated the comparative clinical outcomes between SES and PES, and found no significant difference in the long-term …”

“…16,17) Mezilis, et al reported that a combined strategy consisting of RA and DES reduced the rate of MACE combined with TLR, TVR, stroke, MI, and occurrence of death in 150 patients with heavily calcified coronary artery lesions. They reported excellent TLR and MACE results of 2% and 11.3%, respectively.…”

“…14,15) Other studies demonstrated that long-term clinical outcomes of DES implantation after RA were feasible. 16,17) In these studies, multiple types of DES including SES and paclitaxel-eluting stents (PES) were implanted. However, data that compared the clinical outcomes between SES and PES after RA are limited.…”

Clinical Characteristics and Long-Term Outcomes of Rotational Atherectomy ― J2T Multicenter Registry ―

“…[7][8][9][10][11] This increase in adverse event rates is thought to be associated with a higher patient risk profile and the complexity of the coronary anatomy, rather than the specific procedure itself. 12 Patient and lesion characteristics are thus important for the long-term outcome of RA for heavily calcified lesions.…”

Comparison of Clinical and Angiographic Outcomes After Bare Metal Stents and Drug-Eluting Stents Following Rotational Atherectomy

“…Previous studies reported that the clinical and angiographic outcomes in DES-RA were compared to those in BMS-RA and DES alone, but the follow-up period was a maximum of 3 years. [12][13][14][15][16][17][18][19] Furthermore, there is little data regarding comparisons between 1st generation DES and 2nd DES after RA. It was not surprising that the angiographic results in DES were superior to those in BMS in the current analysis because several studies demonstrated a favorable angiographic outcome for RA followed by DES compared with RA-BMS [12][13][14][15][16][17][18][19] in the treatment of calcified complex lesions.…”