ASEAN Heart Journal

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Original Article

ASEAN Heart Journal

January 2016, 24:1

First online: 19 January 2016

Original Article

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

Bin Zhang,1 Feng Wang,1 Jack Wei Chieh Tan,2 Hongtao Liao,1 Weilu Chai,1 Huimin Yu,1 Hong Yan,1 Lijun Jin1
Open Access
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  • Summary
  • Supplementary Material
  • References
  • About this Article

Summary

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).

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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.

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Results:
587 CTO lesions in 525 patients were treated. The mean age of patients was 61.6 ¬Ī 10.2 years-old. 30% had diabetes mellitus. Mean LVEF was 56 ¬Ī 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¬Ī0.55mm,18 cases used the 1.25mm burr and 7 cases used the 1.5mm burr. Reference burr / vessel diameter ratio was 0.46¬Ī 0.20mm. No patients required adjunct 2b3a inhibitor usage. The procedural success rate was 96.2% and no peri-procedural MACE was observed.

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Conclusion:
RA was a safe and effective adjunct therapy for calcifi ed CTO lesions that failed balloon dilatation.

Keywords:
Chronic total occlusion (CTO) - Rotational atherectomy - Percutaneous coronary intervention

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12nd section of Cardiology Department, Guangdong Cardiovascular Institute, Guangdong General Hospital, the Guangdong Academy of Medical Science, Guangzhou 510080, China

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2* Co-author, Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609

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Correspondence: 1. Dr Zhang Bin, Guangdong Academy of Medical Science, email: [email protected] 2. Dr Jack Tan, National Heart Centre Singapore, email: [email protected], telephone (65) 67048892.

‚Äč Open Access: This article is distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0) which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

Supplementary Material

Nil

 

References

1. Bittl JA, Chew DP, Topol EJ, Kong DF, Califf RM. Metaanalysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty.¬†J Am Coll Cardiol¬†2004;43:936‚Äď42. CrossRef¬†¬† ¬†PubMed

2. Moreno R, Conde C, Perez-Vizcayno MJ,¬†et al. Prognostic impact of a chronic occlusion in a noninfarct vessel in patients with acute myocardial infarction and multivessel disease undergoing primary percutaneous coronary intervention.¬†J Invasive Cardiol¬†2006;18:16‚Äď9. PubMed

3. Prasad A, Rihal CS, Lennon RJ, Wiste HJ, Singh M, Holmes DR, Jr. Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the Mayo Clinic.¬†J Am Coll Cardiol¬†2007;49:1611‚Äď8. CrossRef¬†¬†PubMed

4. Ron Waksman SS. Chronic Total Occlusions: A Guide to Recanalization 2nd edition. In: John Wiley & Sons, Ltd, 2013:38;2013.

5. Fefer P, Knudtson ML, Cheema AN,¬†et al. Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry.¬†J Am Coll Cardiol¬†2012;59:991‚Äď7. CrossRef¬†¬†PubMed

6. King SB, 3rd, Yeh W, Holubkov R,¬†et al. Balloon angioplasty versus new device intervention: clinical outcomes. A comparison of the NHLBI PTCA and NACI registries.¬†J Am Coll Cardiol¬†1998;31:558‚Äď66. CrossRef¬†¬†PubMed

7. Bittl JA.¬†Directional coronary atherectomy versus balloon angioplasty.¬†N Engl J Med¬†1993;329:273‚Äď4. CrossRef¬†¬†PubMed

8. Moliterno DJ.¬†Rotational atherectomy for resistant chronic total occlusions: another spin for tough old problems.¬†Catheter Cardiovasc Interv¬†2010;76:372‚Äď3. CrossRef¬†¬†PubMed

9. Walton AS, Pomerantsev EV, Oesterle SN,¬†et al. Outcome of narrowing related side branches after high-speed rotational atherectomy.¬†Am J Cardiol¬†1996;77:370‚Äď3. CrossRef¬†¬†PubMed

10. Tsuchikane E, Suzuki T, Asakura Y,¬†et al. Debulking of chronic coronary total occlusions with rotational or directional atherectomy before stenting: Final results of DOCTORS study.¬†Int J Cardiol¬†2008;125:397‚Äď403. CrossRef¬†¬†PubMed

11. Whitlow PL, Bass TA, Kipperman RM,¬†et al. Results of the study to determine rotablator and transluminal angioplasty strategy (STRATAS).¬†Am J Cardiol¬†2001;87:699‚Äď705. CrossRef¬†PubMed

12. Fernandez JP, Hobson AR, McKenzie D,¬†et al. Beyond the balloon: excimer coronary laser atherectomy used alone or in combination with rotational atherectomy in the treatment of chronic total occlusions, non-crossable and non-expansible coronary lesions.¬†EuroIntervention¬†2013;9:243‚Äď50. CrossRef¬†¬†PubMed

13. Pagnotta P, Briguori C, Mango R,¬†et al. Rotational atherectomy in resistant chronic total occlusions.¬†Catheter Cardiovasc Interv¬†2010;76:366‚Äď71. CrossRef ¬†PubMed

About this Article

Title

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


Open Access

Available under Open Access


Journal

>> ASEAN Heart Journal 
>> 24:1


Online Date

21 November 2019


DOI

10.7603/s40602-016-0001-8


Online ISSN

2315-4551


Publisher

ASEAN Federation of Cardiology


Additional Links

>> About The AHJ


Topics

Cardiology


Keywords

Chronic total occlusion (CTO)
Rotational atherectomy
Percutaneous coronary intervention


Author Affiliations

1. section of Cardiology Department, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, 510080, Guangzhou, China
2. Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore, Singapore


Correspondence to Bin Zhang, [email protected]
ack Wei Chieh Tan, [email protected]