Thin-strut drug-eluting stents are more favorable for severe calcified lesions after rotational atherectomy than thick-strut drug-eluting stents.
OBJECTIVE
Percutaneous coronary intervention (PCI) for severe calcified lesions is still challenging, and there are few studies of drug-eluting stent (DES) implantation for severe calcified lesions, especially regarding long-term results and hemodialysis patients. The study purpose was to clarify the factors, including DES strut thickness, that affect the long-term outcome of severe calcified lesion treated with rotational atherectomy.


METHODS
We analyzed 79 consecutive patients (138 stents) with DES implantation for severe calcified lesions that required rotational atherectomy before stent implantation. Rotational atherectomy was performed for the lesions that showed over 270° severe calcification by intravascular ultrasound (IVUS) or where IVUS could not cross the lesion. We compared coronary risk factors, acute coronary syndrome and hemodialysis, the patients' history of coronary bypass graft and myocardial infarction, medication, and procedure characteristics, including the thickness of the DES used (thin- or thick-strut [>100 μm] DES) between the patients with target vessel revascularization (TVR) versus those without TVR.


RESULTS
During the follow-up, TVR was performed in 30 patients (38.5%). A multivariate analysis revealed that age and thin-strut DES were independently related to TVR (P=.01 for both). A Kaplan-Meier curve showed a lower TVR rate in the thin-strut DES patients compared to the thick-strut DES patients.


CONCLUSIONS
For severe calcified lesions that needed rotational atherectomy, thin-strut DESs resulted in lower rates of TVR compared to thick-strut DESs.
Division of Cardiology, Osaka Rosai Hospital. 1179-3, Nagasone-cho, Sakai-city, Osaka 591-8025, Japan. mnishino@orh.go.jp.
Yasuharu
Y
Lee
Akihiro
A
Tanaka
Naoki
N
Mori
Takahiro
T
Yoshimura
Daisuke
D
Nakamura
Masayuki
M
Taniike
Nobuhiko
N
Makino
Yasuyuki
Y
Egami
Ryu
R
Shutta
Jun
J
Tanouchi
Masami
M
Nishino
D000368:Aged; D017225:Atherectomy, Coronary / Q000295:instrumentation* / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D023903:Coronary Restenosis / Q000453:epidemiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery; D054855:Drug-Eluting Stents / Q000145:classification*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional