title: Long-term outcomes of rotational atherectomy for the percutaneous treatment of chronic total occlusions.
abstract: OBJECTIVE
  To study the long-term outcomes of rotational atherectomy (RA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  There is little evidence on the incidence, procedural results and long-term outcomes of RA for CTO PCI.
  
  
  METHODS
  This registry included data from consecutive patients undergoing CTO PCI at four specialized centers. Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and ischemia-driven target-vessel revascularization) on follow-up were the primary endpoint.
  
  
  RESULTS
  A total of 1003 patients were included. Of these, 35 (3.5%) required RA. As compared with Conventional PCI, RA patients were older (68.9 ± 9.5 vs. 64.6 ± 10.7 years, P = 0.02), had higher prevalence of diabetes (58% vs. 37%, P = 0.01) and of a J-CTO score ≥2 (80% vs. 58%, P = 0.009), driven by severe calcification. Antegrade wire escalation was used more frequently in RA (74% vs. 53%, P = 0.08). RA was performed for balloon failure-to-cross in 51% and failure-to-expand in 49%. One burr was utilized in 86%. The 1.25-mm burr was the largest burr used in 43%. Slow flow/no-reflow was observed in 17%. No other serious RA-related complications were observed. Procedural success was 77% vs. 89% (P = 0.04) in RA vs. Conventional PCI. After a mean follow-up of 658 ± 412 days, MACE rates were similar between groups (15% vs. 13%, P = 0.70).
  
  
  CONCLUSIONS
  The use of RA in CTO PCI was safe, despite a worse patient risk profile and higher procedural complexity, as compared with conventional techniques. Although procedural success was lower in the RA group, there were no differences in long-term clinical outcomes between groups. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Azzalini
authors.affiliation: Interventional Cardiology, Department of Medicine, McGill University Medical Center, Montreal, QC, Canada.|Interventional Cardiology, Department of Medicine, Quebec Heart and Lung Institute and Laval University, Quebec City, QC, Canada.
authors.forename: Rustem
authors.initials: R
authors.lastname: Dautov
authors.affiliation: Interventional Cardiology, Department of Cardiology, Reina Sofía Hospital, University of Córdoba (IMIBIC), Córdoba, Spain.
authors.forename: Soledad
authors.initials: S
authors.lastname: Ojeda
authors.affiliation: Interventional Cardiology, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
authors.affiliation: Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Benincasa
authors.affiliation: Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bellini
authors.affiliation: Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Giannini
authors.affiliation: Interventional Cardiology, Department of Cardiology, Reina Sofía Hospital, University of Córdoba (IMIBIC), Córdoba, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Chavarría
authors.affiliation: Interventional Cardiology, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Livia L
authors.initials: LL
authors.lastname: Gheorghe
authors.affiliation: Interventional Cardiology, Department of Cardiology, Reina Sofía Hospital, University of Córdoba (IMIBIC), Córdoba, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Pan
authors.affiliation: Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.affiliation: Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Interventional Cardiology, Department of Medicine, McGill University Medical Center, Montreal, QC, Canada.|Interventional Cardiology, Department of Medicine, Quebec Heart and Lung Institute and Laval University, Quebec City, QC, Canada.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Rinfret
mesh_terms: D000368:Aged; D017225:Atherectomy, Coronary / Q000379:methods*; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: chronic total occlusion; percutaneous coronary intervention; rotational atherectomy