Initiation of a Rotational Atherectomy Program: Single Center Experience

Background: Percutaneous coronary intervention (PCI) in severely calcified coronary arteries is associated with suboptimal outcome due to difficulty in achieving adequate lesion dilation and increased risk of coronary perforation. Rotational atherectomy (RA) effectively ablates coronary calcification, however it is rarely used due to technical challenges and increased cost. Due to increasing complexity of coronary disease in elderly patients referred for treatment at our tertiary center we decided to initiate a RA program in 2016 and report our initial experience.

Methods: We analyzed a prospective registry of RA procedures performed between April 2016 and November 2018.

Results: 42patients underwent RA during the study period. The average age was 77±9 years, 62% were male, mean GFR was 69±27 ml/min and average left ventricular ejection fraction of 51±9%. Procedures were performed electively in 60% of the patients and 61% had previously undergone unsuccessful coronary interventions in the lesions treated by RA. The unprotected left main coronary artery was treated in 14% of the cases, trans-radial vascular access was used in 14% and temporary pacemakers were used in 7%. Burr size ranged between 1.25-2.0 mm and a single burr was used in 40% of the cases. A satisfactory angiographic result was achieved in 41/42 (98%) cases with a single procedural complication of transient no-reflow. No additional procedure-related complications occurred over 462±264 days of follow-up. Four deaths (9%) occurred 413±361days following procedure (range: 104-847).

Conclusions: A RA program was successfully initiated and enabled successful treatment of complex calcified coronary lesions with an excellent safety profile.