Rotablation in the treatment of patients with heavily calcified coronary artery disease

Background: PCI in heavily calcified coronary arteries has historically been a significant challenge. This study was to investigate the safety and efficacy of using rotational atherectomy (RA) in treating such lesions. Method: From October 2007 to April 2013, all patients who received RA in our catheter lab were enrolled. The clinical and angiographic characteristics at the time of index PCI and two year outcomes were analysed. Results: 36 patients (total of 40 lesions) with a mean age of 71.3 years were enrolled. 94% were male. 19% were diabetic. 31% had previously had CABG. 78% had triple-vessel disease. Temporary pacing wire was used in 25%, activated in 1 patient. The angiographic success rate was 98%. 30% had a radial approach. 6F guides were used in 75%. Lesion sites were: 12% LM, 38% LAD, 20% Cx, and 30% RCA. The mean stenosis was 86%. 98% of lesions were heavily calcified. A single burr was used in 83%, with 74% being 1.5mm burrs. Mean stent number was 1.4. Seven patients died at a mean of 2.2 years (4 non-cardiac). Procedural complications included 1 cardiac tamponade, 1 sub-acute stent thrombosis, 1 dissection extending to the aorta, 1 femoral dissection, and 2 patients had slow-flow on completion. 53% of all patients had a re-study within 2 years. Of these, 5% had target vessel revascularisation (TVR), 10% had target lesion revascularisation and 22% had non-TVR. Conclusion: Rotablation is a relatively safe and successful procedure in a high risk group of patients.