High speed rotational atherectomy: Outcome in calcified and noncalcified coronary artery lesions

• Published in: Journal of the American College of Cardiology 1995-09, Vol.26 (3), p.731-736
• Main Authors: MacIsaac, Andrew I., Bass, Theodore A., Buchbinder, Maurice, Cowley, Michael J., Leon, Martin B., Warth, David C., Whitlow, Patrick L.
• Format: Article
• Language: English
• Subjects: Aged; Atherectomy, Coronary - adverse effects; Atherectomy, Coronary - instrumentation; Atherectomy, Coronary - methods; Atherectomy, Coronary - statistics & numerical data; Biological and medical sciences; Calcinosis - complications; Calcinosis - diagnostic imaging; Calcinosis - surgery; Chi-Square Distribution; Confidence Intervals; Coronary Angiography; Coronary Disease - complications; Coronary Disease - diagnostic imaging; Coronary Disease - surgery; Diseases of the cardiovascular system; Female; Humans; Incidence; Logistic Models; Male; Medical sciences; Middle Aged; Postoperative Complications - epidemiology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Registries - statistics & numerical data; Retrospective Studies; Treatment Outcome; United States - epidemiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(95)00206-J

This study sought to determine the success and complication rates of high speed rotational coronary atherectomy in calcified and noncalcified lesions. Percutaneous transluminal coronary angioplasty and directional coronary atherectomy of calcified lesions are associated with reduced procedural success and increased complications. Rotational atherectomy using the Rotablator catheter abrades noncompliant plaque and may improve outcome in calcified lesions. Data from the completed Multicenter Rotablator Registry of 2,161 rotational atherectomy procedures in single lesions were analyzed to determine the relative efficacy of rotational atherectomy for 1,078 calcified and 1,083 noncalcified lesions. The power of the study was 0.86 to detect a significant difference in outcome, if the true success rates in the noncalcified and calcified lesions were 96% and 93%, respectively. Patients with calcified lesions were older (mean [±SD] age 66.2 ± 10.3 vs. 60.5 ± 11.0 years, p = 0.0001) than those with noncalcified lesions. Calcified lesions were more frequently new (75% vs. 64%, p = 0.0001), angulated (27% vs. 22%, p = 0.02), eccentric (75% vs. 64%, p = 0.0001) and long (32% vs. 27%, > 10 mm in length, p = 0.01). They were also more often complex (57% vs. 46%, p = 0.001) and located in the left anterior descending coronary artery (51% vs. 44%, p = 0.001). Adjunctive coronary angioplasty was used in 82.9% of calcified and 66.9% of noncalcified lesions. Procedural success, defined as