The Application of Rotational Atherectomy in PCI of Coronary Chronic Total Occlusions

OBJECTIVE: The aim of the study is to investigate the effi cacy, complication rate and predictors of rotational atherectomy (RA) usage after successful guidewire crossing during percutaneous coronary intervention (PCI) of coronary chronic total occlusion (CTO). METHODS: A single center experience of 525 consecutive patients from October 2010 to June 2014. A total of 587 CTO lesions were treated. After successful guidewire crossing, lesions that could not be crossed with the smallest 1.25mm balloon underwent RA with 1.25mm and or 1.5mm burrs after exchanging for the Rotawire through a microcatheter. Post RA, the CTO lesions are then pre-dilated successfully before stenting with drug eluting stents (DES). Patients were then clinically followed up for inpatient MACE and restenosis. RESULTS: 587 CTO lesions in 525 patients were treated. The mean age of patients was 61.6 ± 10.2 years-old. 30% had diabetes mellitus. Mean LVEF was 56 ± 12%. The overall successful CTO PCI rate was 87%. 22% required the retrograde CTO approach. 26 CTO lesions in 26 patients (4.43%) underwent RA. RA and stent deployment were successfully performed in 25 patients. One lesion was unsuccessful because the Rotawire could not cross the lesion. Reference lesion diameter was 2.87±0.55mm,18 cases used the 1.25mm burr and 7 cases used the 1.5mm burr. Reference burr / vessel diameter ratio was 0.46± 0.20mm. No patients required adjunct 2b3a inhibitor usage. The procedural success rate was 96.2% and no peri-procedural MACE was observed. CONCLUSION: RA was a safe and effective adjunct therapy for calcifi ed CTO lesions that failed balloon dilatation.