Key result
Direct rotational atherectomy was associated with a lower rate of technical failure or severe coronary dissection compared to indirect rotational atherectomy (11.9% vs 24.4%; P<0.001).
Why the study?
Data on the optimal timing of rotational atherectomy (RA) during PCI for severely calcified coronary lesions were limited.
Does direct rotational atherectomy reduce technical failure or severe coronary dissection compared to indirect rotational atherectomy in patients with severe calcific coronary artery disease?
Observational
Yes
Does direct rotational atherectomy reduce technical failure or severe coronary dissection compared to indirect rotational atherectomy in patients with severe calcific coronary artery disease?
Early application of direct rotational atherectomy in severe calcific coronary lesions is associated with a lower risk of technical failure and severe coronary dissection compared to an indirect strategy.
May favor direct over indirect rotational atherectomy in calcific lesions; hypothesis-generating and requires randomized confirmation.
Owing to limited data on the optimal timing of rotational atherectomy (RA), we sought to evaluate the clinical impact of the early application of the RA strategy. Consecutive patients with severe coronary artery calcification were enrolled, who underwent percutaneous coronary intervention (PCI) using RA between January 2010 and October 2019 at 9 tertiary centers. Direct RA was defined as the early application of RA before the balloon was expanded to a size more than or equal to 2.0 mm. The primary endpoint was the composite outcome of technical failure or severe coronary dissection (type D, E, or F) during entire procedure. Of 581 lesions, 360 (62.0%) lesions underwent direct RA. The technical success rate was higher in the direct RA group than in the indirect RA group (97.5% vs. 93.7%, p = 0.021). The primary endpoint was more frequently observed in the indirect RA group than in the direct RA group (24.4% vs. 11.9%, p < 0.001). Multivariate logistic regression analysis revealed that the risk of the primary endpoint was higher in the indirect RA group than in the direct RA group (odds ratio 2.512, 95% CI 1.547-4.078, p < 0.001). Early application of RA may reduce the incidences of in-hospital adverse events and procedure-related complications.
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Lee et al. (2025) conducted an observational in Severe coronary artery calcification. Direct rotational atherectomy vs. Indirect rotational atherectomy was evaluated on Composite outcome of technical failure or severe coronary dissection (type D, E, or F) during entire procedure (OR 2.512, 95% CI 1.547-4.078, p=<0.001). Direct rotational atherectomy was associated with a lower rate of technical failure or severe coronary dissection compared to indirect rotational atherectomy (11.9% vs 24.4%; P<0.001).
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