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Rotational Atherectomy (RA) is an effective tool in PCI to treat undilatable lesions prior to stent implantation when balloon dilation fails. Nowadays it seems to be of increasing interest as patients get older and show complex lesions, often containing chronic total occlusions (CTO). Due to excellent development of CTO-equipment wiring occlusive lesions often works, but balloon crossing fails. In this case RA is a valid option to open the occluded artery. We compared success- and complication rates of RA in non-CTO vs CTO-lesions.
Among 10833 consecutive PCI-pts, approx 10% with CTO-lesions, 348 pts showed severely calcified lesions that were not balloon dilatable and needed RA prior to stent implantation (3.2%). This study population comprised 85 RA-pts with CTO-lesions (approximately 10% of the CTO-cohort) and 263 RA-pts with non-CTO lesions (2.5% of the non-CTO-cohort).
Patients demographics were not different between pts with CTO (n=85) and non-CTO (n=263), most were male (85% in both groups), showed typical cardiovascular risc factors and had a preserved ejection fraction (56±10 vs 57 ±9). Regarding the procedural characteristics CTO-pts showed more ostial lesions (25% vs 13%) and in average needed more stents (1.86±1.2 vs 1.51±0.9) respectively increased stent length (52±30 vs 34±20). Burr size was smaller in CTO-RA (1.53±0.2 vs 1.61±0.17). RA-success was achieved in 98.8% in CTO and 97.4% in non-CTO pts. Severe complications occurred in 1.2% in CTO vs 2.7% in non-CTO pts. The only complication in CTO-RA was cardiac decompensation. Complications in non-CTO-RA were vessel perforation resulting in tamponade (0.4%), vessel perforation sealed by ballooning (0.8%), tamponade caused by temporary pacing lead during RA (0.4%), cardiogenic shock (0.8%) and burr entrapment (0.4%).
Our analysis suggests that RA in CTO-lesions has the same success rate and is not associated with a higher complication rate than RA in non-CTO-lesions despite longer occluded lesions and likely more dissections due to subintimal wire tracking in CTO. This seems to be of particular interest regarding the fact that RA is even more often required in CTO- than in non-CTO lesions.
CORONARY: Atherectomy (excluding thrombectomy)