ArticleIndian heart journal
Safety, Efficacy, and Outcomes of the Modified Rotational Atherectomy Approach: A Real-World Single-Center Experience.
Article in Indian heart journal. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRotational atherectomy (RA) is advantageous in calcified coronary lesions to ablate calcified plaques and optimize stent expansion but associated with complications like coronary perforation, dissection, and slow/no-reflow.
aimTo evaluate the safety and periprocedural outcomes of RA with a modified approach in a real-world Indian scenario.
methodsThis 6-year, retrospective, single-operator study at an Indian tertiary care institution included 320 patients, operated using a modified RA approach, which integrated slow burr speed (150,000-155,000 revolutions per minute), short runs and pretreatment adrenaline with aminophylline to avoid temporary pacemaker (TPM). Data on demographics, periprocedural characteristics, and complications were collected. The primary endpoint was angiographic and procedural success.
resultsThe patient cohort comprised predominantly men (80.31%) with a mean age of 67.92 ± 9.16 years. Common comorbidities included acute coronary syndrome (67.81%), diabetes mellitus (50.93%), and hypertension (67.81%). A total of 322 RA procedures (414 lesions) were performed. Of these 414 lesions, 7% were chronic total occlusions while 8.9% were in the left main coronary artery. TPM insertion was done in one (0.31%) patient who already had complete heart block. Imaging was performed in 35% of the procedures. Procedural success was achieved in 96.90% of the cases. Complications included slow flow/no-reflow in 4 cases (1.24%), dissection in 4 cases (1.24%), and burr entrapment in 2 cases (0.62%).
conclusionThe use of TPM can be avoided during RA, and slow/no reflow incidence can be reduced with pretreatment aminophylline and adrenaline. Small burr sizes with a slow rotation speed and short runs are key for safe and effective calcium ablation with this debulking modality.
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