Rotational atherectomy for fibro-calcific coronary artery disease in drug eluting stent era: procedural outcomes and angiographic follow-up results.
OBJECTIVE
The aim of this study was to examine the binary re-stenosis rates, procedural success, and in hospital outcomes following treatment of fibro-calcified coronary lesion with rotational atherectomy in drug eluting stent era.


BACKGROUND
Binary restenosis rates have remained high with the use of bare metal stents following rotational atherectomy in calcified lesions. There is limited data available following rotational atherectomy in drug eluting stent era.


METHODS
We evaluated the procedural and angiographic outcomes following a consecutive series of 516 procedures treated with rotational atherectomy followed by stenting. We compared the results between Rota + Drug eluting stent (DES) and Rota + bare metal stent (BMS) groups.


RESULTS
Procedural success was achieved in 97.1% of the lesions with overall low in hospital adverse events (death in 1.1%, Q MI in 1.3%, Non Q MI in 5.3%, and urgent repeat PCI in 0.4%). There was significant reduction in the binary restenosis rates following Rota + DES use as compared to Rota + BMS use (11% vs. 28.1%, P < 0.001; OR = 3.17, 95% CI: 1.76-5.93) and similar reduction was seen in the target lesion revascularization (10.6% vs. 25%, P = 0.001; OR = 2.81, 95% CI: 1.53-5.14). We have identified ostial lesions, chronic total occlusion lesions, and use of bare metal stents as independent predictors of restenosis in this group of patients.


CONCLUSIONS
Rotational atherectomy can be performed with high success rates and low complications, and rotational atherectomy followed by drug eluting stent implantation significantly reduces binary restenosis rates in fibrocalcific lesions as compared to rotational atherectomy and bare metal stents.
Rathore
Sudhir
S
Department of Cardiology, Toyohashi Heart Center, Oyama-cho, Toyohashi, Japan. sudhirrathore@hotmail.com
Matsuo
Hitoshi
H
Terashima
Mitsuyasu
M
Kinoshita
Yoshihisa
Y
Kimura
Masashi
M
Tsuchikane
Etsuo
E
Nasu
Kenya
K
Ehara
Mariko
M
Asakura
Yasushi
Y
Katoh
Osamu
O
Suzuki
Takahiko
T
D000368:Aged; D017225:Atherectomy, Coronary; D002114:Calcinosis / Q000601:surgery*; D009202:Cardiomyopathies / Q000601:surgery*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D018084:Ultrasonography, Interventional