Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Cardiovascular Intervention
Impact of Rotational Atherectomy on Heavily Calcified, Unprotected Left Main Disease
– The New Tokyo Registry –
Hiroto Yabushita, Kensuke Takagi, Satoko Tahara, Yusuke Fujino, Takayuki Warisawa, Hiroyoshi Kawamoto, Yusuke Watanabe, Satoru Mitomo, Kenichi Karube, Takahiro Matsumoto, Tomohiko Sato, Toru Naganuma, Tsuyoshi Kobayashi, Hisaaki Ishiguro, Keiko Fukino, Naoyuki Kurita, Shotarou Nakamura, Koji Hozawa, Sunao Nakamura
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Keywords: Drug-eluting stent, Ischemic heart disease, Percutaneous coronary intervention
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2014 Volume 78 Issue 8 Pages 1867-1872

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Abstract

Background:There is little data on percutaneous coronary intervention (PCI) using rotational atherectomy (Rota) for severely calcified unprotected left main (ULM) lesions.Methods and Results:Between January 2005 and August 2011, 64 consecutive patients who underwent drug-eluting stent implantation using Rota were retrospectively evaluated. Of these, 54.7% and 20.3% patients had diabetes and were undergoing hemodialysis (HD), respectively. The mean EuroSCORE and SYNTAX score was 5.6 and 35.4, respectively. Procedural success, defined as residual stenosis <30%, was achieved in 95.3% of patients without fatal complications. Periprocedural myocardial infarction occurred in 7.8% patients. At the 1-year follow up, cardiac death was observed in 6.3% of patients, and target lesion revascularization (TLR) and TLR in the main branch (TLR-MB) were required in 18.8% and 10.9% patients, respectively. Optimal stent expansion was achieved in the majority of 33 patients with available intravascular ultrasound (IVUS) data. However, 5 of 9 HD patients who underwent IVUS required TLR-MB despite optimal stent expansion. The rate of TLR-MB was significantly lower in the non-HD patients than in the HD patients (2.1% vs. 46.2%; P=0.003).Conclusions:PCI using Rota for calcified ULM lesions might guarantee high procedural success and a low complication rate. Although acceptable results were obtained at the 1-year follow up for non-HD patients, the rate of TLR-MB was considerably high for HD patients despite optimal stent expansion. (Circ J 2014; 78: 1867–1872)

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© 2014 THE JAPANESE CIRCULATION SOCIETY
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