Long-Term Outcomes Reported for Rotational Atherectomy in Treatment of CTO

January 23, 2017—Findings from a study of the long-term outcomes of rotational atherectomy (RA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) were published by Lorenzo Azzalini, MD, et al online in Catheterization and Cardiovascular Interventions (CCI).

According to the investigators, this registry included data from consecutive patients undergoing CTO PCI at four specialized centers in Europe. The primary endpoint was major adverse cardiac events (MACE; eg, cardiac death, target-vessel myocardial infarction, and ischemia-driven target-vessel revascularization) at follow-up.

As summarized in CCI, the study was composed of 1,003 patients, of which 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 = .02), had higher prevalence of diabetes (58% vs 37%; P = .01), and more likely to have a Japan J-CTO score ≥ 2 (80% vs 58%; P = .009), driven by severe calcification.

The investigators reported that antegrade wire escalation was used more frequently in RA (74% vs. 53%; P = .08). RA was performed for balloon failure to cross in 51% and failure to expand in 49% of procedures. One burr was utilized in 86% of procedures and the 1.25-mm burr was the largest burr used in 43% of procedures. Slow flow/no-reflow was observed in 17% of cases. No other serious RA-related complications were observed.

Procedural success was 77% versus 89% (P = .04) in RA versus conventional PCI. After a mean follow-up of 658 ± 412 days, MACE rates were similar between groups (15% vs 13%; P = .70).

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, concluded the investigators in CCI.