Safety and feasibility of rotational atherectomy (RA) versus conventional stenting in patients with chronic total occlusion (CTO) lesions: a systematic review and meta-analysis

Ahmed Abdelaziz; Hanaa Elsayed; Aboalmagd Hamdaalah; Karim Atta; Ahmed Mechi; Hallas Kadhim; Aya Moustafa Aboutaleb; Ahmed Elaraby; Mohamed Hatem Ellabban; Fayed Mohamed Rzk; Mahmoud M. A. Eid; Hadeer Elsaeed AboElfarh; Rahma AbdElfattah Ibrahim; Emad Addin Zawaneh; Mahmoud Ezzat; Mohamed Abdelaziz; Abdelrahman Hafez; Shaimaa Fadel; Hazem S. Ghaith; Mustafa Suppah

doi:10.1186/s12872-023-03673-2

Why the study?

Interventional cardiologists face challenges managing chronic total occlusion lesions, with conflicting results comparing rotational atherectomy to conventional PCI.

Does rotational atherectomy improve clinical and angiographic outcomes compared to conventional PCI in patients with chronic total occlusion lesions?

Structured PICO

Does rotational atherectomy improve clinical and angiographic outcomes compared to conventional PCI in patients with chronic total occlusion lesions?

P

Population

7 studies comprising 5,494 patients with chronic total occlusion (CTO) lesions

I

Intervention

Rotational atherectomy (RA)

C

Comparator

Conventional stenting / conventional percutaneous coronary intervention (PCI)

O

Outcome

Major adverse cardiovascular events (MACE)composite

Rotational atherectomy yields comparable clinical and angiographic outcomes to conventional PCI in chronic total occlusion lesions, supporting its feasibility and safety for complex calcified lesions.

Implication

RA comparable to conventional PCI in CTO; leaves open whether routine use improves outcomes pending randomized trials.

Abstract

BACKGROUND AND AIM: Interventional cardiologists face challenges in managing chronic total occlusion (CTO) lesions, with conflicting results when comparing rotational atherectomy (RA) to conventional PCI. This meta-analysis aims to provide a critical evaluation of the safety and feasibility of RA in CTO lesions. METHODS: PubMed, Scopus, Web of Science, Ovid, and Cochrane central library until April 2023 were searched for relevant studies. MACE was our primary outcomes, other outcomes were all cause of death, cardiac death, MI, and TVR. Also, we reported angiographic outcomes as technical success, procedural success, and procedural complications in a random effect model. The pooled data was analyzed using odds ratio (OR) with its 95% CI using STATA 17 MP. RESULTS: Seven studies comprising 5494 patients with a mean follow-up of 43.1 months were included in this meta-analysis. Our pooled analysis showed that RA was comparable to PCI to decrease the incidence of MACE (OR = 0.98, 95% CI [0.74 to 1.3], p = 0.9). Moreover, there was no significant difference between RA and conventional PCI in terms of other clinical or angiographic outcomes. CONCLUSION: Our study showed that RA had comparable clinical and angiographic outcomes as conventional PCI in CTO lesions, which offer interventional cardiologists an expanded perspective when addressing calcified lesions. PROSPERO REGISTRATION: CRD42023417362.