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Review
. 2023 Sep;112(9):1143-1163.
doi: 10.1007/s00392-022-02013-2. Epub 2022 Apr 28.

Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials

Abdelhakim Allali  1 , Mohamed Abdel-Wahab  2 , Karim Elbasha  3 , Nader Mankerious  3 , Hussein Traboulsi  3 , Adnan Kastrati  4 , Mohamed El-Mawardy  5 , Rayyan Hemetsberger  3 , Dmitriy S Sulimov  2 , Franz-Josef Neumann  6 , Ralph Toelg  3 , Gert Richardt  3
Affiliations
Review

Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials

Abdelhakim Allali et al. Clin Res Cardiol. 2023 Sep.

Abstract

With growing experience, technical improvements and use of newer generation drug-eluting stents (DES), recent data showed satisfactory acute and long-term results after rotational atherectomy (RA) in calcified coronary lesions. The randomized ROTAXUS and PREPARE-CALC trials compared RA to balloon-based strategies in two different time periods in the DES era. In this manuscript, we assessed the technical evolution in RA practice from a pooled analysis of the RA groups of both trials and established a link to further recent literature. Furthermore, we sought to summarize and analyze the available experience with RA in different patient and lesion subsets, and propose recommendations to improve RA practice. We also illustrated the combination of RA with other methods of lesion preparation. Finally, based on the available evidence, we propose a simple and practical approach to treat severely calcified lesions.

Keywords: Calcified coronary lesions; Complex percutaneous coronary intervention; Rotational atherectomy.

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Conflict of interest statement

Dr. Allali is a consultant for Boston Scientific. Dr. Abdel-Wahab declares that his hospital receives speaker’s honoraria and/or consultancy fees on his behalf from Boston Scientific and Medtronic. Dr. Hemetsberger is an honorary speaker for Boston Scientific. Dr. Richardt has received institutional research grants from St. Jude Medical, Biotronik and Medtronic. Dr. Neumann reports lectures fees paid to his institution from Amgen, Bayer Healthcare, Biotronic, Boehringer Ingelheim, Boston Scientific, Daiichi Sankyo, Edwards Lifesciences, Ferrer, Pfizer, Novartis; consultancy fees paid to his institution from Boehringer Ingelheim; grant support from Bayer Healthcare, Boston Scientific, Biotronic, Edwars Lifesciences, GlaxoSmithKline, Medtronic and Pfize. The other authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Burr selection for rotational atherectomy
Fig. 2
Fig. 2
Main quantitative coronary angiography findings of rotational atherectomy arms form PREPARE-CALC and ROTAXUS trials. ALG acute lumen gain; LLL late lumen los; QCA quantitative coronary angiography
Fig. 3
Fig. 3
Nine months outcome of rotational atherectomy arms form PREPARE-CALC and ROTAXUS trials. MACE major adverse cardiovascular events; MI myocardial infarction; PCI percutaneous coronary intervention; TLR target lesion revascularization; TVR target vessel revascularization
Fig. 4
Fig. 4
Elective and bailout rotational atherectomy. RA rotational atherectomy
Fig. 5
Fig. 5
Practical approach to treat calcified coronary lesions. *Use of floppy RotaWire™ and small burr are recommended to avoid complications by wire bias. CB cutting balloon; DES drug-eluting stents; IVL intra-vascular lithotripsy; NC-Balloon non-compliant balloon; OPN-Balloon super high-pressure balloon; RA rotational atherectomy
See this image and copyright information in PMC

References

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