Author + information
- Received June 1, 1994
- Revision received March 30, 1995
- Accepted April 7, 1995
- Published online September 1, 1995.
- Andrew I. MacIsaac, MBBS, FRACPa,
- Theodore A. Bass, MD, FACC*,
- Maurice Buchbinder, MD, FACC†,
- Michael J. Cowley, MD, FACC‡,
- Martin B. Leon, MD, FACC§,
- David C. Warth, MD, FACC‖ and
- Patrick L. Whitlow, MD, FACCa,*
- ↵*Address for correspondence: Dr. Patrick L. Whitlow, Department of Cardiology F25, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44106.
Objectives This study sought to determine the success and complication rates of high speed rotational coronary atherectomy in calcified and noncalcified lesions.
Background Percutaneous transluminal coronary angioplasty and directional coronary atherectomy of calcified lesions are associated with reduced procedural success and increased complications. Rotational atherectomy using the Rotablator catheter abrades noncompliant plaque and may improve outcome in calcified lesions.
Methods Data from the completed Multicenter Rotablator Registry of 2,161 rotational atherectomy procedures in single lesions were analyzed to determine the relative efficacy of rotational atherectomy for 1,078 calcified and 1,083 noncalcified lesions. The power of the study was 0.86 to detect a significant difference in outcome, if the true success rates in the noncalcified and calcified lesions were 96% and 93%, respectively.
Results Patients with calcified lesions were older (mean [±SD] age 66.2 ± 10.3 vs. 60.5 ± 11.0 years, p = 0.0001) than those with noncalcified lesions. Calcified lesions were more frequently new (75% vs. 64%, p = 0.0001), angulated (27% vs. 22%, p = 0.02), eccentric (75% vs. 64%, p = 0.0001) and long (32% vs. 27%, > 10 mm in length, p = 0.01). They were also more often complex (57% vs. 46%, p = 0.001) and located in the left anterior descending coronary artery (51% vs. 44%, p = 0.001). Adjunctive coronary angioplasty was used in 82.9% of calcified and 66.9% of noncalcified lesions. Procedural success, defined as <50% residual stenosis without major complication, was achieved in 94.3% of calcified and 95.2% of noncalcified lesions (p = 0.32). Major complication rates were 4.1% in calcified and 3.1% in noncalcified lesions (p = 0.24). Non-Q wave myocardial infarction was documented in 10.0% of calcified and 7.7% of noncalcified lesions (p = 0.054). Mean postprocedural residual stenosis was 21.6 ± 13.9% in calcified and 23.3 ± 15% in noncalcified lesions (p = 0.39).
Conclusions In this review of data from a large multicenter registry, the success rate of rotational atherectomy was not reduced by calcification despite the more frequent complex nature of the calcified lesions. The Rotablator catheter is likely to be the device of choice for percutaneous intervention in calcified lesions, but definitive conclusions await the results of randomized trials.
Support for this study was provided by Heart Technology, Inc., Redmond, Washington, Dr. Buchbinder has a financial interest in Heart Technology, Inc., Redmond, Washington, manufacturer of the Rotablator System.
- Received June 1, 1994.
- Revision received March 30, 1995.
- Accepted April 7, 1995.
- American College of Cardiology