Long-Term Outcomes after Rotational Atherectomy for Calcified Chronic Total Occlusion versus Nonchronic Total Occlusion Coronary Lesions
Background. The role of rotational atherectomy (RA) in contemporary percutaneous coronary intervention (PCI) is expanding to include certain chronic total occlusion (CTO) lesions. However, the long-term outcome of RA in CTOs is still unclear. Objective. To investigate in-hospital and long-term outco...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Hindawi-Wiley
2022-01-01
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| Series: | Journal of Interventional Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2022/2593189 |
| _version_ | 1797958163279904768 |
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| author | Karim Elbasha Nader Mankerious Mohamed Alawady Ghada Ibrahim Radwa Abdullah Mohamed Abdel-Wahab Rayyan Hemetsberger Ralph Toelg Gert Richardt Abdelhakim Allali |
| author_facet | Karim Elbasha Nader Mankerious Mohamed Alawady Ghada Ibrahim Radwa Abdullah Mohamed Abdel-Wahab Rayyan Hemetsberger Ralph Toelg Gert Richardt Abdelhakim Allali |
| author_sort | Karim Elbasha |
| collection | DOAJ |
| description | Background. The role of rotational atherectomy (RA) in contemporary percutaneous coronary intervention (PCI) is expanding to include certain chronic total occlusion (CTO) lesions. However, the long-term outcome of RA in CTOs is still unclear. Objective. To investigate in-hospital and long-term outcomes after RA for CTO compared to non-CTO calcified lesions. Moreover, this report evaluates the role of the elective RA approach in calcified CTOs. Methods and Results. This study enrolled 812 patients (869 lesions; CTO, n = 80 versus non-CTO, n = 789). The mean age of the study population was 73.1 ± 8.6 years, the baseline characteristics were comparable in both groups. Balloon-resistant CTO lesions represented the main indication for RA in CTO patients (61.2%). The mean J-CTO score was 2.42 ± 0.95. The angiographic success rate was lower in CTO patients (88.8% vs 94.9%; p = 0.022). In-hospital major adverse cardiac events (MACE) rate was comparable in both groups (CTO 8.8% vs 7.0% in non-CTO;p = 0.557). At two-year follow-up, a higher target lesion failure (TLF) was observed in CTO group (25.5% vs 15.1%, log rank p = 0.041), driven by higher cardiac mortality while the clinically driven target lesion revascularisation (TLR) was comparable between the study groups. Elective RA for CTO had a shorter procedural time and lower rate of dissection (7.5% vs 25%; p = 0.030) compared to bail-out RA with similar long-term outcomes. Conclusion. Compared to non-CTO, RA for CTO can be performed with a high procedural success rate and comparable in-hospital outcomes. Apart from higher cardiac mortality in the CTO group, the long-term outcomes are comparable in both groups. Elective RA is a feasible and beneficial approach to be used in CTO intervention. |
| first_indexed | 2024-04-11T00:16:05Z |
| format | Article |
| id | doaj.art-1a43bf1c2e70400ca7ce4be63983ea34 |
| institution | Directory Open Access Journal |
| issn | 1540-8183 |
| language | English |
| last_indexed | 2024-04-11T00:16:05Z |
| publishDate | 2022-01-01 |
| publisher | Hindawi-Wiley |
| record_format | Article |
| series | Journal of Interventional Cardiology |
| spelling | doaj.art-1a43bf1c2e70400ca7ce4be63983ea342023-01-09T01:30:18ZengHindawi-WileyJournal of Interventional Cardiology1540-81832022-01-01202210.1155/2022/2593189Long-Term Outcomes after Rotational Atherectomy for Calcified Chronic Total Occlusion versus Nonchronic Total Occlusion Coronary LesionsKarim Elbasha0Nader Mankerious1Mohamed Alawady2Ghada Ibrahim3Radwa Abdullah4Mohamed Abdel-Wahab5Rayyan Hemetsberger6Ralph Toelg7Gert Richardt8Abdelhakim Allali9Cardiology DepartmentCardiology DepartmentCardiology DepartmentCardiology DepartmentCardiology DepartmentCardiology DepartmentCardiology DepartmentCardiology DepartmentCardiology DepartmentCardiology DepartmentBackground. The role of rotational atherectomy (RA) in contemporary percutaneous coronary intervention (PCI) is expanding to include certain chronic total occlusion (CTO) lesions. However, the long-term outcome of RA in CTOs is still unclear. Objective. To investigate in-hospital and long-term outcomes after RA for CTO compared to non-CTO calcified lesions. Moreover, this report evaluates the role of the elective RA approach in calcified CTOs. Methods and Results. This study enrolled 812 patients (869 lesions; CTO, n = 80 versus non-CTO, n = 789). The mean age of the study population was 73.1 ± 8.6 years, the baseline characteristics were comparable in both groups. Balloon-resistant CTO lesions represented the main indication for RA in CTO patients (61.2%). The mean J-CTO score was 2.42 ± 0.95. The angiographic success rate was lower in CTO patients (88.8% vs 94.9%; p = 0.022). In-hospital major adverse cardiac events (MACE) rate was comparable in both groups (CTO 8.8% vs 7.0% in non-CTO;p = 0.557). At two-year follow-up, a higher target lesion failure (TLF) was observed in CTO group (25.5% vs 15.1%, log rank p = 0.041), driven by higher cardiac mortality while the clinically driven target lesion revascularisation (TLR) was comparable between the study groups. Elective RA for CTO had a shorter procedural time and lower rate of dissection (7.5% vs 25%; p = 0.030) compared to bail-out RA with similar long-term outcomes. Conclusion. Compared to non-CTO, RA for CTO can be performed with a high procedural success rate and comparable in-hospital outcomes. Apart from higher cardiac mortality in the CTO group, the long-term outcomes are comparable in both groups. Elective RA is a feasible and beneficial approach to be used in CTO intervention.http://dx.doi.org/10.1155/2022/2593189 |
| spellingShingle | Karim Elbasha Nader Mankerious Mohamed Alawady Ghada Ibrahim Radwa Abdullah Mohamed Abdel-Wahab Rayyan Hemetsberger Ralph Toelg Gert Richardt Abdelhakim Allali Long-Term Outcomes after Rotational Atherectomy for Calcified Chronic Total Occlusion versus Nonchronic Total Occlusion Coronary Lesions Journal of Interventional Cardiology |
| title | Long-Term Outcomes after Rotational Atherectomy for Calcified Chronic Total Occlusion versus Nonchronic Total Occlusion Coronary Lesions |
| title_full | Long-Term Outcomes after Rotational Atherectomy for Calcified Chronic Total Occlusion versus Nonchronic Total Occlusion Coronary Lesions |
| title_fullStr | Long-Term Outcomes after Rotational Atherectomy for Calcified Chronic Total Occlusion versus Nonchronic Total Occlusion Coronary Lesions |
| title_full_unstemmed | Long-Term Outcomes after Rotational Atherectomy for Calcified Chronic Total Occlusion versus Nonchronic Total Occlusion Coronary Lesions |
| title_short | Long-Term Outcomes after Rotational Atherectomy for Calcified Chronic Total Occlusion versus Nonchronic Total Occlusion Coronary Lesions |
| title_sort | long term outcomes after rotational atherectomy for calcified chronic total occlusion versus nonchronic total occlusion coronary lesions |
| url | http://dx.doi.org/10.1155/2022/2593189 |
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