Can rotablation atherectomy bypass the bypass surgery in 'drug eluting stent' era?

摘要

Background: The patients with heavily calcified lesions, especiallyin LAD or LM are referred to the surgeons. When patientswere unwilling for CABG, Rotablation atherectomy (RA) used tobe popular for mechanical debulking in bare-metal stent era butlater it became less popular as it was technically demandingand outcomes following PTCA were not promising. This studywas done to evaluate our institutional experience with RA andfollowed by DES implantation in heavily calcified coronarylesions.Methods: From August, 2012 to July, 2014 we had 18 cases ofheavily calcified de novo lesions that underwent RA followed byDES implantation. The database at base line and all follow-upvisits were analyzed.Results: A total of 18 patients underwent RA for heavily calcifiedcoronary lesions followed by DES implantation during the studyperiod. Of them 60% were diabetics. Multivessel disease was seenin 6 patients. The lesions that had RA were eLAD (13), LCx (3) andRCA (2). Of them 30% were either balloon-non-crossable or nondilatable(1.25mmballoon). Procedural success was 17/18 (94.4 %).There were no procedure related MACE at 30 days. At meanfollow-up of 5.5 ± 1.35 months, 1 developed CRF and 1 neededelective CABG.Conclusion: RA followed by DES was safe with promising acuteand short term results in patients with heavily calcified coronarylesions and bypass surgery could be avoided in almost all of them.