Key result
Rotational atherectomy followed by cutting balloon before stent implantation significantly reduced the risk of long-term in-stent restenosis compared to plain balloon in patients with calcified coronary lesions (HR 0.136).
Why the study?
Does rotational atherectomy followed by cutting balloon improve acute lumen gain and reduce long-term in-stent restenosis compared to plain balloon in patients with calcified coronary lesions?
Observational (n=127)
No
Does rotational atherectomy followed by cutting balloon improve acute lumen gain and reduce long-term in-stent restenosis compared to plain balloon in patients with calcified coronary lesions?
Hazard Ratio: 0.136 (95% CI 0.02–0.936)
Absolute Event Rate: 4.5% vs 20.5%
p-value: p=0.043
In patients with calcified coronary lesions, using a cutting balloon rather than a plain balloon after rotational atherectomy improves acute lumen diameter and reduces long-term in-stent restenosis.
May support cutting balloon after rotational atherectomy in calcified lesions; leaves open randomized confirmation of restenosis reduction.
BACKGROUND: Coronary calcification is a major determinant of stent underexpansion and subsequent adverse events. This study aimed to evaluate the acute- and long-term outcomes of rotational atherectomy (RA) followed by cutting balloon (CB) versus plain balloon before drug-eluting stent implantation for calcified coronary lesions. METHODS: From June April 2013 to March 2016, a total of 127 patients with moderately or severely calcified coronary lesions were treated with RA. Patients were divided into two groups according to the balloon type after RA: RA+CB group (n = 75) and RA+plain balloon group (n = 52). Minimal lumen diameter and acute lumen gain were analyzed by quantitative coronary angiography. In-hospital and long-term (>1 year) outcomes were recorded. Multivariate Cox regression analysis was performed to determine the independent predictors of in-stent restenosis. RESULTS: The mean age of the patients was 65.5 years, and 76.4% were men. Total lesion length and minimal lumen diameter at baseline were similar in the two groups. After RA and balloon dilation, the lumen diameter was significantly larger in the RA+CB group than in the RA+plain balloon group (1.57 ± 0.46 mm vs. 1.10 ± 0.40 mm, t = 4.123, P < 0.001). The final lumen diameter was also larger in the RA+CB group compared to that in the RA group (2.81 ± 0.41 mm vs. 2.60 ± 0.25 mm, t = 2.111, P = 0.039). Moreover, patients receiving RA and CB tended to have larger final lumen gain (2.15 ± 0.48 mm vs. 1.95 ± 0.47 mm, t = 1.542, P = 0.132). Multivariate Cox regression analysis indicated that the strategy of RA+CB was a significant protective factor against long-term (>1 year) in-stent restenosis (hazard ratio: 0.136, 95% confidence interval: 0.020-0.936, P = 0.043). CONCLUSIONS: In patients with moderately or severely calcified lesions, a strategy of RA followed by CB before stent implantation can increase lumen diameter and acute lumen gain. This strategy is safe with lower risk of long-term in-stent restenosis.
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Ai et al. (2018) conducted an observational in Moderately or severely calcified coronary lesions (n=127). Rotational atherectomy followed by cutting balloon vs. Rotational atherectomy followed by plain balloon was evaluated on Long-term (>1 year) in-stent restenosis (HR 0.136, 95% CI 0.020-0.936, p=0.043). Rotational atherectomy followed by cutting balloon before stent implantation significantly reduced the risk of long-term in-stent restenosis compared to plain balloon in patients with calcified coronary lesions (HR 0.136).
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