January 2016, 24:1

19 January 2016

Original Article

Original Article

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

Bin Zhang, Feng Wang, Jack Wei Chieh Tan, Hongtao Liao, Weilu Chai, Huimin Yu,Hong Yan, Lijun Jin

ASEAN Heart Journal

First online: 

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Abstract

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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.

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

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

Correspondence: 1. Dr Zhang Bin, Guangdong Academy of Medical Science, email: drbinzgang@163.com. 2. Dr Jack Tan, National Heart Centre Singapore, email: jack.tan.w.c.@singhealth.com.sg, telephone (65) 67048892.

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.

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