Low-speed rotational atherectomy with substantial debulking and long-term survival: a retrospective observational study of 889 consecutive patients

Abstract

Background: In recent years, a series of studies have investigated long-term outcome of rotational atherectomy (RA). However, only little attention was given to the procedural details of RA technique, especially with regard to platform speed.

Aims: The aim of the study was to evaluate the impact of low-speed RA with substantial debulking before stenting on long-term mortality.

Methods: A group of 356 patients with a high plaque burden underwent substantial debulking with RA with low platform speed of 135 000 rpm and was compared with a group of 553 patients treated without RA in the same time period. In both cohorts lesion preparation was followed by stent implantation. The endpoint was all-cause mortality up to 80 months with a mean (SD) follow-up of 49 (24) months.

Results: Despite the fact that patients treated with RA were significantly older and presented more unfavorable lesion characteristics than non-RA patients, there was no significant difference in long-term survival between groups. A propensity analysis with 279 matched pairs showed that long-time survival in RA patients was better than in non-RA patients (hazard ratio, 0.52; CI, 0.32–0.85; P < 0.01).

Conclusions: Substantial debulking with RA continues to play a role in the treatment of calcified coronary arteries. We hypothesize that RA with low platform speed and substantial debulking with a burr-to-artery ratio of up to 0.64 results in favorable long-time survival in patients with high plaque burden. However, this can only be proved in a prospective randomized trial.