Adjunctive Procedures (Thrombectomy, Atherectomy, Special Balloons)
Clinical Impact of Direct Rotational Atherectomy in Patients with Complex Coronary Artery Lesions
Kyusup Lee1, Sung-Ho Her2
The Catholic University of Korea Daejeon St. Mary's Hospital, Korea (Republic of)1, The Catholic University of Korea St. Vincent's Hospital, Korea (Republic of)2
Data is still limited regarding the clinical impact of direct rotational atherectomy(RA) in patients with complex coronary artery lesions during percutaneous coronary intervention(PCI).
Using the “Clinical Outcome of ROtational atherectomy in Calcified lesions in Korea(ROCK)” registry, we sought to examine the effect of the direct RA on procedural outcomes and complications in patients undergoing PCI compared to the indirect RA. The outcomes of interest were procedural outcomes including procedural time, contrast amount, and radiation dose, technical and procedural success rates, in-hospital major adverse cerebral and cardiac events (MACCEs), and procedure-related complications.
Procedure time was significantly shorter in the direct RA compared to the indirect RA [60 min (interquartile range (IQR), 42-90 min) indirect RA vs. 68 min (IQR, 50-106 min), p<0.001]. Technical and procedural success rate, in-hospital MACCEs and procedure-related complication were similar between the two groups. There was no event of cardiac tamponade and in-hospital stroke in the direct RA. Also, severe coronary artery dissection and coronary perforation were numerically less frequently observed in the direct RA compared to the indirect RA.
Direct RA showed more efficient strategy compared to indirect RA regarding procedure time. Severe coronary dissection during the procedure and coronary perforation were less frequently observed in direct RA. Further randomized study may be warranted.