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Rotational atherectomy in CTO PCI yields similar long-term outcomes vs. conventional PCI
In patients undergoing PCI for chronic total occlusion, the use of rotational atherectomy appears to be safe and yields no difference in long-term clinical outcomes vs. conventional PCI, according to recent findings.
In the large multicenter registry, researchers evaluated data on 1,007 consecutive all-comer patients treated with CTO PCI at one of four study sites from 2009 to 2015. MACE, defined as cardiac death, target vessel MI and ischemia-driven target vessel revascularization, was designated as the primary endpoint.
The researchers found that, of the 1,003 patients who underwent PCI, rotational atherectomy was used in only 35 cases (3.5%). Compared with patients in the conventional PCI cohort, those in the rotational atherectomy cohort were older (68.9 years vs. 64.6 years; P = .02), were more frequently diabetic (58% vs. 37%; P = .01), had a higher prevalence of Multicenter CTO Registry of Japan (J-CTO) score ≥ 2 (80% vs. 58%; P = .009), which was attributable to severe calcification, and had a worse left ventricular ejection fraction (47.7% vs. 53.7%; P = .02).
Rotational atherectomy procedures more often used in antegrade wire escalation vs. conventional PCI procedures (74% vs. 53%; P = .08). Failure-to-cross was the reason for conversion to rotational atherectomy in 51% of cases, the researchers wrote, and failure-to-expand prompted rotational atherectomy in 49%. Eighty-six percent of rotational atherectomy procedures used one burr, and the 1.25-mm burr was the largest burr used in 43% of procedures. In 17% of cases, slow flow/no reflow occurred, but no other major rotational atherectomy-related complications were reported. Rotational atherectomy yielded a 77% rate of procedural success vs. 89% in conventional PCI (P = .04). At a mean follow-up of 658 days, the rotational atherectomy and conventional groups had comparable rates of MACE (rotational atherectomy, 15%; conventional, 13%; P = .7), according to the findings.
“In a large, contemporary and multicenter registry of all-comer patients undergoing CTO PCI, [rotational atherectomy] was required in a small proportion of cases,” the researchers wrote. “The use of [rotational atherectomy] to achieve CTO recanalization was safe, both following a true-to-true lumen approach and when dissection/reentry techniques were used.” – by Jennifer Byrne
Disclosure: One researcher reports receiving consulting fees from Boston Scientific and research funding from Abbott Vascular and Medtronic.