Author + information
- Meena Narayanan,
- David Shavelle,
- Ray V. Matthews,
- Anilkumar Mehra and
- Leonardo Clavijo
Significant coronary calcification is a challenge for percutaneous coronary intervention (PCI). Rotational atherectomy is useful for plaque modification prior to stent delivery. In the present study, we report our experience with left main disease and rotational atherectomy.
From January 2008 to January 2017, all patients who underwent left main stenting with rotational atherectomy were evaluated. Clinical characteristics and follow-up outcomes are reported.
A total of 57 patients were included in our registry. Mean age was 72.9 years ± 9.9 years. Diabetes and chronic kidney disease were seen in 57.9% and 33.3% of patients, respectively. Fifteen patients (26.3%) presented with unstable angina, 22 patients (38.6%) with non-ST-elevation myocardial infarction, 2 patients (3.5%) with ST-elevation myocardial infarction, and 7 patients (12.3%) with cardiogenic shock. The mean ejection fraction was 37.1 ± 15%. Fifty-four patients (94.7%) had evidence of multivessel disease and 38 patients (67%) underwent rotational atherectomy with intra-aortic balloon pump assistance. Angiographic success, defined by residual stenosis of <20% and presence of TIMI 3 flow, was obtained in all patients. The mean number of implanted drug-eluting stents was 1.9 ± 0.7 and bare metal stents was 1.3 ± 0.5 per patient. Two patients (3.5%) died during the index hospitalization. In-hospital morbidity defined by acute renal failure, bleeding and vascular complications and recurrent chest pain with ischemic changes occurred in 8 patients (14%). Repeat PCI was performed in 4 patients (7%).
Despite technical challenges, rotational atherectomy of left main can be completed with a high success rates in patients with low in-hospital mortality and morbidity.
|Left Main and Rotablator (n=57)|
|Diabetes Mellitus||33 (57.9)|
|Chronic Kidney Disease||19 (33.3)|
|Prior CABG||20 (35.1)|
|Prior MI||17 (29.8)|
|Prior PCI||15 (26.3)|
|History of CVA||9 (15.8)|
|Cardiogenic Shock||7 (12.3)|
|Ejection fraction, %||37.1±15.5|
|Stable Angina||11 (19.3)|
|Unstable Angina||15 (26.3)|
|In-hospital mortality||2 (3.5)|
|In-hospital morbidity||8 (14.0)|
|Repeated PCI||4 (7.0)|