title: Rotational atherectomy in very long lesions: Results for the ROTATE registry.
abstract: BACKGROUND
  Rotational atherectomy (RA) is relatively contraindicated in patients with lesions ≥25 mm of length. Aim of this study was to evaluate RA safety and efficacy in this subset of patients with new technology and devices.
  
  
  RESULTS
  From April 2002 to August 2013, the ROTATE registry included all consecutive patients undergoing RA in 8 centres. They were divided into shorter lesion group (SLG, lesions < 25 mm) and longer lesion group (LLG, lesions ≥ 25 mm). The angiographic success (AS) was the primary end point. Procedural complications (PC), a composite end point of procedural perforation, slow flow/no flow, and in-hospital major acute cardiovascular events (MACE), were secondary end points, along with death, nonfatal MI, target lesion revascularization, and MACE during follow-up. Sensitivity analysis was performed according to generation of DES. 1186 patients were included: 51.5% in SLG and 48.4% in LLG. Mean age was 70.4 ± 9.3 years, 64.5% were male. AS and PC did not differ between the two groups (93% vs 91%, p = 0.24 and 9.8 vs 9.4%, p = 0.84). During follow-up (27.6 ± 22.9 months), MACE did not differ between the two groups (28% vs 29.1%, p = 0.95). At multivariate analysis chronic kidney disease, male gender increased risk of MACE (HR 1.94, IQR 1.29-2.0, p = 0.01, HR 0.52, IQR 0.34-0.79, p = 0.01) while second-generation DES seemed protective (HR 0.53, IQR 0.31-0.88, p = 0.02). Data were confirmed at sensitivity analysis for second-generation DES (759 pts, 63.9%). No differences were found in this subpopulation between the two groups in term of AS, PC, and long-term MACE (93.6% vs 93.5%, p = 0.28, 11.9% vs 9.4%, p = 0.32 and 25.5% vs 23.9%, p = 0.72, respectively).
  
  
  CONCLUSIONS
  Treating coronary lesions ≥ 25 mm length with RA does not impact short- and long-term outcome, in particular, in patients with second-generation DES. © 2016 Wiley Periodicals, Inc.
authors.affiliation: "Citta' Della Scienza e della Salute", University of Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Iannaccone
authors.affiliation: "Citta' Della Scienza e della Salute", University of Turin, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Barbero
authors.affiliation: "Citta' Della Scienza e della Salute", University of Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'ascenzo
authors.affiliation: Italy and EMO-GVM Centro Cuore Columbus, San Raffaele Scientific Institute, Milan, Milan, Italy.
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.affiliation: Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pennacchi
authors.affiliation: Division of Cardiology, Istituto Humanitas, Milan, Italy.
authors.forename: Marco Luciano
authors.initials: ML
authors.lastname: Rossi
authors.affiliation: Cardiology Department, Ospedale San Giovanni Bosco, Torino, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ugo
authors.affiliation: Interventional Cardiology Unit, a.O. Ordine Mauriziano Umberto I, Turin, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Meliga
authors.affiliation: Interventional cardiology unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Kawamoto
authors.affiliation: "Citta' Della Scienza e della Salute", University of Turin, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Department of Cardiology, Azienda Ospedaliera Bolognini Seriate, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ielasi
authors.affiliation: Cardiology Department, Ospedale San Giovanni Bosco, Torino, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Garbo
authors.affiliation: Italy and EMO-GVM Centro Cuore Columbus, San Raffaele Scientific Institute, Milan, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sardella
authors.affiliation: Cardiology Department, Ospedale San Giovanni Bosco, Torino, Italy.
authors.forename: Giacomo G
authors.initials: GG
authors.lastname: Boccuzzi
mesh_terms: D000368:Aged; D017225:Atherectomy, Coronary / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: calcific lesion; rotablator; rotational atherectomy; second-generation DES