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

Abstract

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.

Assessment of Safety and Feasibility of Rotational Atherectomy (Ra) Versus Conventional Stenting in Patients With Chronic Total Occlusion (Cto) Lesions

“…Our results indicate that both RA and conventional stenting are viable treatment options for CTO lesions with comparable safety and efficacy profiles. Despite specific differences in procedural qualities and outcomes, for example, procedural time and fluoroscopy time, the two gatherings accomplished comparative paces of procedural achievement and difficulty rates (9,10). Besides, the adequacy measures, including the recurrence of periprocedural myocardial dead tissue (MI), top troponin level, and mean change in left ventricular discharge portion (LVEF), were comparative between the two gatherings, recommending that the two techniques are successful in improving myocardial perfusion and capability in patients with CTO sores (11).…”

Kết quả của thủ thuật khoan phá mảng xơ vữa vôi hoá động mạch vành bằng Rotablator tại Viện Tim mạch Việt Nam, Bệnh viện Bạch Mai

“…13 Các tác giả Ma. Y và cộng sự 14 , Wang, J và cộng sự 15 thực hiện RA cho tổn thương CTO đã cho thấy được tính an toàn, hiệu quả trong ngắn hạn và dài hạn tương tự như nhóm tổn thương CTO không RA. Như vậy, RA là một công cụ có thể được lựa chọn để can thiệp những tổn thương CTO mà bóng nong thông thường không thể nong được tổn thương.…”

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

“…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.…”