Acute Angulation and Sequential Lesion Increase the Risk of Rotational Atherectomy Failure

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  • Tomasiewicz Brunon
    Department of Heart Diseases, Wroclaw Medical University Centre for Heart Diseases, University Hospital
  • Kubler Piotr
    Department of Heart Diseases, Wroclaw Medical University Centre for Heart Diseases, University Hospital
  • Zimoch Wojciech
    Department of Heart Diseases, Wroclaw Medical University Centre for Heart Diseases, University Hospital
  • Kosowski Michał
    Department of Heart Diseases, Wroclaw Medical University Centre for Heart Diseases, University Hospital
  • Wańha Wojciech
    Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
  • Ładziński Szymon
    Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
  • Rakotoarison Oscar
    Department of Heart Diseases, Wroclaw Medical University Centre for Heart Diseases, University Hospital
  • Ochała Andrzej
    Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
  • Wojakowski Wojciech
    Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
  • Reczuch Krzysztof
    Department of Heart Diseases, Wroclaw Medical University Centre for Heart Diseases, University Hospital

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<p>Background:The aim of the study was to assess anatomical and procedural predictors of clinical and procedural failure of rotational atherectomy (RA) in an all-comers population.</p><p>Methods and Results:A total of 534 consecutive patients who underwent RA were included in a double-center observational study. The primary composite endpoint consisted of: rota-wire introduction failure, burr-passage failure, periprocedural complications and procedure-related major adverse events. The second primary endpoint included rota-wire introduction failure and burr-passage failure. The primary endpoint occurred in 76 (14.2%) patients and the second primary endpoint occurred in 64 (12%) Periprocedural complications occurred in 23 (4.3%) and procedure-related adverse events in 23 (4.3%) patients. Multivariable analysis revealed angulation on lesion ≤90° (HR=2.18, 95% CI: 1.21–3.94, P=0.0096) and sequential lesion (HR=1.89, 95% CI: 1.01–3.54, P=0.046) as independent predictors of no clinical success of RA. Multivariable analysis revealed again that angulation on lesion ≤90° (HR=2.26, 95% CI: 1.16–4.40, P=0.02) and sequential lesion (HR=3.77, 95% CI: 1.64–8.69, P<0.01) as independent predictors of no procedural success of RA.</p><p>Conclusions:The presence of an acute angulation on lesion and sequential lesion are independent determinants of clinical and procedural failure of RA. Further research is necessary to establish a score predicting RA failure, which can help in preproceduralrisk stratification of patients undergoing complex percutaneous coronary intervention with RA.</p>

収録刊行物

  • Circulation Journal

    Circulation Journal 85 (6), 867-876, 2021-05-25

    一般社団法人 日本循環器学会

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