18 Rotational atherectomy in the modern cardiac catheterisation laboratory patient demographics, procedural characteristics and clinical outcomes

Aim The objective of this study was to define the patient demographics, periprocedural characteristics and mid to long term outcomes associated with rotational atherectomy in modern clinical practice in Ireland. Methods We performed a retrospective analysis of all patients who underwent rotational atherectomy in two Irish centres. Data on all patients was collected from the electronic patient records system. Baseline characteristics were collected for all patients. This included demographic and procedural characteristics. Demographic characteristics included age, co-morbidities, medications and presentation. Long term follow up was obtained at 3 and 12 months to assess clinical response. NYHA functional class and CCS angina scores were evaluated at 3 months and 12 months post procedure. 66 cases were identified over the study period and a database of patients was produced. Results 66% of patients were male. Mean age was 72±8.12 years (Range 54–86 years). 90.6% of our patients were hypertensive, 32.3% were diabetic. 28.33% had CKD and 96.88% had hypercholesterolaemia. 44% were current smokers, 35.6% never smokers and 20.33% ex-smokers. Mean weight was 79.66±17.67 kg (Range 42.6–124 kg) and mean creatinine was 104.77±70.03 (Range 56–398). 40.6% of patients had previous PCI, 31.25% had previous failed attempts at PCI and 15.625% had previously had coronary artery bypass grafting. 98.5% of patients were on Aspirin and 92.3% were on a second antiplatelet agent. Periprocedural complications were detailed for all procedures based on pre-specified criteria. The most common complications reported were coronary artery dissection (9.09%) and bleeding (9.2%). 2 patients required dialysis post procedure (3.03%), 1 patient required emergency CABG (1.5%) and 1 patient suffered cardiac death (1.5%). Coronary artery rupture and cardiac tamponade did not occur in any cases. We also analysed for any association between outcomes and categorical variables. These included burr size, femoral vs radial access and age (Over/Under 75). We found no statistically significant difference between complication rates between cases with burr size 1.25 mm and cases using burr size of over 1.25 mm (18.4% vs 10%, p=0.33). Similarly complication rates were not significantly different for radial versus femoral access (23.5% vs 23.9%, p=0.974) and age over/under 75 (17.8% vs 28%, p=0.900919) Patients were assessed at 3 months and 12 months to assess clinical status post rotational atherectomy. Canadian cardiovascular society grading of angina pectoris and New York heart association functional scores were utilised. Mean CCS score at 3 months was 0.26±0.77 (Range 0–3) and this persisted out until 12 months (0.25±0.657). NYHA score at 3 months was 0.5±0.993 and again, this persisted until 12 months (0.457±0.816), indicating that the clinical benefit of rotational atherectomy is maintained until 1 year post procedure. Conclusions Whilst less commonly used in modern day intervention, rotational atherectomy still has a role in the drug eluting stent era to modify heavily calcified plaque. The risk of MACEs remains higher than conventional PCI, reflecting the complexity of the disease and increased procedural technical difficulty.

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