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Comparison of perioperative and hospital results of rotational atherectomy or balloon-based techniques to prepare severely calcified coronary lesions

Authors: Petrosian K.V., Abrosimov A.V., Badeev K.Yu., Buziashvili Yu.I., Donakanyan S.A., Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2024-18-2-202-213

For citation: Petrosian K.V., Abrosimov A.V., Badeev K.Yu., Buziashvili Yu.I., Donakanyan S.A., Golukhova E.Z. Comparison of perioperative and hospital results of rotational atherectomy or balloon-based techniques to prepare severely calcified coronary lesions. Creative Cardiology. 2024; 18 (2): 202–213 (in Russ.). DOI: 10.24022/1997-3187-2024-18-2-202-213

Received / Accepted:  23.01.2024 / 09.04.2024

Keywords: calcified coronary artery lesions rotational atherectomy balloon techniques



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Abstract

Objective. To compare intraoperative and hospital outcomes of rotational atherectomy (RA) and balloon angioplasty in the preparation of calcified lesions for drug-eluting stent implantation.

Material and methods. This retrospective study, conducted at the Bakulev Center for Cardiovascular Surgery, included 149 patients with calcified coronary artery lesions. The patients were divided into two groups: group 1 (48 patients) – RA, and group 2 (101 patients) – non-compliant balloons (NCB). Percutaneous coronary intervention (PCI) control was performed using intravascular ultrasound (IVUS). Control points were the risk of MACE (cardiac death, acute myocardial infarction (AMI), target lesion revascularization (TLR)), hospital mortality, peri-procedural or hospital AMI, TLR, stent expansion (%), minimum stent area (MSA) according to IVUS, procedure success, and coronary artery perforation and dissection.

Results. The risk of in-hospital MACE was significantly higher in group 2 (NCB) – odds ratio (OR) 5.74 (95% confidence interval (CI) 1.12–45.86), p = 0.0193. No hospital mortality was observed. Peri-procedural or hospital AMI occurred only in group 2 (NCB) – 9.9% (n = 10) compared to 0% in group 1 (RA), OR 4.6 (95% CI 1.07–37.39), p = 0.043. The frequency of TLR did not differ between the groups: OR 0.95 (95% CI 0.08–10.74), p = 0.9669. Stent expansion was higher in group 1 (RA) – 78.6±3.1 vs. 74.4±7.6% in group 2 (NCB), p<0.01. MSA was also higher in group 1 (RA) – 6.1±0.4 mm vs. 5.7±0.5 mm, p<0.01. Procedure success was higher in group 1 (RA) – 97.9 vs. 85.1% in group 2 (NCB), OR 0.12 (95% CI 0.02–0.95), p = 0.0022. The frequency of perforations and dissections did not differ between the groups.

Conclusion. Rotational atherectomy for the preparation of calcified lesions for stent implantation demonstrates better clinical perioperative and hospital outcomes and is associated with a higher rate of successful PCI and better stent expansion.

References

  1. Madhavan M.V., Tarigopula M., Mintz G.S., Maehara A., Stone G.W., Généreux P. Coronary artery calcification: pathogenesis and prognostic implications. J. Am. Coll. Cardiol. 2014; 63 (17): 1703–1714. DOI: 10.1016/j.jacc.2014.01.017
  2. Buiten R.A., Ploumen E.H., Zocca P., Doggen C.J.M., van Houwelingen K.G., Danse P.W. et al. Three contemporary thin-strut drug-eluting stents implanted in severely calcified coronary lesions of participants in a randomized all-comers trial. Catheter. Cardiovasc. Interv. 2020; 96 (5): E508–E515. DOI: 10.1002/ccd.28886
  3. Abdel-Wahab M., Toelg R., Byrne R.A., Geist V., El-Mawardy M., Allali A. et al. High-speed rotational atherectomy versus modified balloons prior to drug-eluting stent implantation in severely calcified coronary lesions. Circ. Cardiovasc. Interv. 2018; 11 (10): e007415. DOI: 10.1161/CIRCINTERVENTIONS.118.007415
  4. Dill T., Dietz U., Hamm C.W., Küchler R., Rupprecht H.J., Haude M. et al. A randomized comparison of balloon angioplasty versus rotational atherectomy in complex coronary lesions (COBRA study). Eur. Heart J. 2000; 21: 1759–1766. DOI: 10.1053/euhj.2000.2242
  5. Räber L., Mintz G.S., Koskinas K.C., Johnson T.W., Holm N.R., Onuma Y. et al. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur. Heart J. 2018; 39 (35): 3281–3300. DOI: 10.1093/eurheartj/ehy285
  6. De Maria G.L., Scarsini R., Banning A.P. Management of calcific coronary artery lesions: is it time to change our interventional therapeutic approach? JACC Cardiovasc. Interv. 2019; 12 (15): 1465–1478. DOI: 10.1016/j.jcin.2019.03.038
  7. Rheude T., Fitzgerald S., Allali A., Mashayekhi K., Gori T., Cuculi F. et al. Rotational atherectomy or balloon-based techniques to prepare severely calcified coronary lesions. JACC Cardiovasc. Interv. 2022; 15 (18): 1864–1874. DOI: 10.1016/j. jcin.2022.07.034
  8. Bockeria L.A., Bockeria O.L., Petrosyan K.V., Karaev A.V., Losev V.V., Kudzoeva Z.F. The possibility of using optical coherence tomography for structural analysis of atherosclerotic plaque and its progression. Russian Journal of Thoracic and Cardiovascular Surgery. 2020; 62 (6): 571–576 (in Russ.). DOI: 10.24022/0236-2791-2020-62-6-571-576
  9. Petrosyan K.V., Goncharova E.S., Abrosimov A.V. The possibilities of intravascular imaging in optimizing the results of percutaneouscoronary interventions in patients with complex morphology of coronary lesions. Russian Journal of Thoracic and Cardiovascular Surgery. 2018; 60 (6): 444–452 (in Russ.). DOI: 10.24022/0236-2791-2018-60-6-444-452
  10. Fujimura T., Matsumura M., Witzenbichler B., Metzger D.C., Rinaldi M.J., Duffy P.L. et al. Stent expansion indexes to predict clinical outcomes: an IVUS substudy from ADAPT-DES. JACC Cardiovasc. Interv. 2021; 14 (15): 1639–1650. DOI: 10.1016/j. jcin.2021.05.019
  11. Kereiakes D.J., Di Mario C., Riley R.F., Fajadet J., Shlofmitz R.A., Saito S. et al. Intravascular lithotripsy for treatment of calcified coronary lesions: patient-level pooled analysis of the disrupt CAD studies. JACC Cardiovasc. Interv. 2021; 14 (12): 1337–1348. DOI: 10.1016/j.jcin.2021.04.015
  12. Wang X., Matsumura M., Mintz G.S., Lee T., Zhang W., Cao Y. et al. In vivo calcium detection by comparing optical coherence tomography, intravascular ultrasound, and angiography. JACC Cardiovasc. Imaging. 2017; 10 (8): 869–879. DOI: 10.1016/j. jcmg.2017.05.014
  13. Cassese S., Byrne R.A., Tada T., Pinieck S., Joner M., Ibrahim T. et al. Incidence and predictors of restenosis after coronary stenting in 10 004 patients with surveillance angiography. Heart. 2014; 100 (2): 153–159. DOI: 10.1136/heartjnl-2013-304933
  14. Cockburn J., Hildick-Smith D., Cotton J., Doshi S., Hanratty C., Ludman P. et al. Contemporary clinical outcomes of patients treated with or without rotational coronary atherectomy – an analysis of the UK central cardiac audit database. Int. J. Cardiol. 2014; 170: 381–387. DOI: 10.1016/j.ijcard.2013.11.018
  15. Whitlow P.L., Bass T.A., Kipperman R.M., Sharaf B.L., Ho K.K., Cutlip D.E. et al. Results of the study to determine rotablator and transluminal angioplasty strategy (STRATAS). Am. J. Cardiol. 2001; 87: 699–705. DOI: 10.1016/s0002-9149(00)01486-7
  16. Isogai T., Yasunaga H., Matsui H., Tanaka H., Fushimi K. Relationship between hospital volume and major cardiac complications of rotational atherectomy: a nationwide retrospective cohort study in Japan. J. Cardiol. 2016; 67: 442–448. DOI: 10.1016/j. jjcc.2015.07.008
  17. Beohar N., Kaltenbach L.A., Wojdyla D., Pineda A.M., Rao S.V., Stone G.W. et al. Trends in usage and clinical outcomes of coronary atherectomy: a Report From the National Cardiovascular Data Registry CathPCI Registry. Circ. Cardiovasc. Interv. 2020; 13: e008239. DOI: 10.1161/CIRCINTERVENTIONS.119.008239
  18. Barbato E., Carrié D., Dardas P., Fajadet J., Gaul G., Haude M. et al. European expert consensus on rotational atherectomy. EuroIntervention. 2015; 11: 30–36. DOI: 10.4244/EIJV11I1A6
  19. Abdel-Wahab M., Richardt G., Joachim Büttner H., Toelg R., Geist V., Meinertz T. et al. High-speed rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: the randomized ROTAXUS (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease) trial. JACC Cardiovasc. Interv. 2013; 6: 10–19. DOI: 10.1016/j.jcin.2012.07.017
  20. Petrosyan K.V., Abrosimov A.V., Karaev A.V., Gurdzibeev A.B., Golukhova E.Z. Rotational coronary atherectomy of coronary arteries – modern trends. Creative Cardiology. 2022; 16 (3): 313–325 (in Russ.). DOI: 10.24022/1997-3187-2022-16-3-00-00

About Authors

  • Karen V. Petrosian, Dr. Med. Sci., Head of Department; ORCID
  • Andrey V. Abrosimov, Cand. Med. Sci., Researcher, Endovascular Surgeon; ORCID
  • Kirill Yu. Badeev, Postgraduate, Endovascular Surgeon; ORCID
  • Yuriy I. Buziashvili, Dr. Med. Sci., Professor, Academician of RAS, Head of Department; ORCID
  • Sergey A. Donakanyan, Dr. Med. Sci., Professor, Head of Department; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of RAS, Director; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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