Rotational Atherectomy and Stent Implantation for Calcified Left Main Lesions

Abstract

BackgroundLeft main coronary artery (LMCA) bifurcation and heavily calcified lesions are common and challenging to treat percutaneously. Rotational atherectomy (RA) may be beneficial in this setting to facilitate stent placement though direct supporting evidence is lacking. This study sought to analyze patients who underwent RA of the LMCA.MethodsConsecutive cases involving RA of the LMCA between 1/1/2004 and 12/31/2009 at a private, tertiary referral hospital were reviewed retrospectively. Medical records, angiograms and clinically driven follow-up were reviewed.ResultsThirty-one cases were identified (20 protected, 11 unprotected), including 23 with stent implantation (21 drug-eluting, 2 bare metal). All 31 lesions had moderate to severe calcification, 84% involved the distal segment. Mean burr-to-vessel ratio was 0.43. Overall angiographic success was 90% (28/31) and was higher with a drug-eluting stent versus no stent (100% vs. 62%; P = 0.0153). In-hospital major adverse cardiovascular events (MACE) occurred in 1 patient (3%). Mid-term MACE occurred in 6 patients (26%) and tended to occur less frequently in patients with protected LMCAs (P = 0.0697). At final follow-up, patients were more likely to be alive and free from angina with a protected LMCA (94% vs. 57% unprotected; P = 0.0564) and with a drug-eluting stent (89% vs. 50% with no stent; P = 0.0281).ConclusionsRA of the LMCA to facilitate stent implantation appears to be safe and effective with favorable mid-term outcomes. In the setting of severe calcification and distal LMCA involvement RA and drug-eluting stent implantation should be considered.

Long-term outcome of rotational atherectomy according to burr-to-artery ratio and changes in coronary artery blood flow: Observational analysis

“…The optimal BtAR remains unidentified, however the current guidelines recommend the burr size of < 0.7 [ 1 ] or < 0.6 [ 2 ] of the vessel diameter. Recently published studies reflecting implementation of recommendations into clinical practice reported the BtAR < 0.6 [ 3 , 19 , 20 ] or even < 0.5 [ 21 , 22 ] for the overall study population. The mean BtAR (SD) calculated for all patients in the present study was 0.50 (0.12).…”

Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials

“…The rate of LMT-RA to the total number of LMT PCIs and to the total number of RA varies among studies from 8.9% to 11.3% and from 6% to 9.3%, respectively [ 46 – 54 ]. The previously published experience with RA in LMT is summarized in Tables 3 , 4 .…”