Rotational Atherectomy in the Drug-Eluting Stent Era: A Single-Center Experience

Background. In heavily calcified lesions, rotational atherectomy (RA) improves procedural success and facilitates stent de - ployment. Reports on RA in the drug-eluting stent (DES) era are lim - ited. The objective of this study was to determine the presenting characteristics, procedural and in-hospital clinical outcomes of patients who underwent RA at our institution in the DES era. Methods. Con - secutive cases involving RA between January 1, 2004 and December 31, 2009 at a private, tertiary referral hospital were reviewed retrospec - tively. Results. A total of 158 patients (236 lesions) who underwent RA are described, including 112 patients (158 lesions) with subsequent DES implantation, 19 patients (28 lesions) with bare-metal stent (BMS) implantation, and 27 patients (50 lesions) with no stent. RA was utilized to modify heavily calcified plaque (84%), as bail-out ther - apy (16%), to preserve the patency of sidebranches (25%) and as de - bulking therapy for chronic total occlusion (13 lesions) and in-stent restenosis (7 lesions). DES were not placed in 46 patients (23%) due to reference vessel diameter 3.75 mm, inability to deliver DES, or desire to avert clopidogrel therapy. Angiographic and proce - dural success rates were significantly higher in the DES and BMS groups compared with the no stent group (angiographic success: 99.1% for DES versus 95% for BMS versus 63% for no stent; p< 0.05; procedural success: 96.4% for DES versus 95% for BMS versus 63% for no stent; p< 0.05). Conclusion. In the DES era, RA remains utilized primarily to modify heavily calcified plaque. In unadjusted analysis, procedural success appears high with subsequent stent place - ment (DES or BMS) versus RA alone. However, 1 in 4 are not candi- dates for stent placement, and the lower procedural success rate in this population should be considered prior to embarking on RA. J INVASIVE CARDIOL 2011;23:133 -139