Low-speed rotational atherectomy with substantial debulking and long-term survival: a retrospective observational study of 889 consecutive patients

Background: In the last years a series of studies have investigated long-term outcome after Rotational Atherectomy (RA). However, only little focus was put on the procedural details of RA-technique especially with regard to platform speed. Aims: To evaluate the outcome of low-speed RA with substantial debulking before stenting on long-term mortality. Methods: A group of 356 patients with high plaque burden underwent substantial debulking by RA with low platform speed of 135 krpm and was compared to a group 553 patients treated without RA in the same time period. In both cohorts lesion preparation was followed by stent implantation. Endpoint of the study was all-cause mortality up to 80 months with a mean observation period of 49±24 months. Results: Despite the fact that patients treated with RA were significantly older and presented more unfavourable lesion characteristics than Non-RA-patients there was no statistically relevant difference in long-term survival between both groups.  A propensity analysis with 279 matched pairs showed that long-time survival in RA-patients was substantially better than in Non-RA patients (HR: 0.52, CI: 0.32-0.85, p< 0.01). Conclusions: Substantial debulking with RA continues to have a role in the treatment of calcified coronaries. We hypothesize that RA with low platform speed and substantial debulking with a burr-to-artery ratio up to 0.64 results in favourable long-time survival outcome in patients with high plaque burden. However, this could only be proven by a prospective randomized trial.