Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials

Clin Res Cardiol. 2023 Sep;112(9):1143-1163. doi: 10.1007/s00392-022-02013-2. Epub 2022 Apr 28.

Abstract

With growing experience, technical improvements and use of newer generation drug-eluting stents (DES), recent data showed satisfactory acute and long-term results after rotational atherectomy (RA) in calcified coronary lesions. The randomized ROTAXUS and PREPARE-CALC trials compared RA to balloon-based strategies in two different time periods in the DES era. In this manuscript, we assessed the technical evolution in RA practice from a pooled analysis of the RA groups of both trials and established a link to further recent literature. Furthermore, we sought to summarize and analyze the available experience with RA in different patient and lesion subsets, and propose recommendations to improve RA practice. We also illustrated the combination of RA with other methods of lesion preparation. Finally, based on the available evidence, we propose a simple and practical approach to treat severely calcified lesions.

Keywords: Calcified coronary lesions; Complex percutaneous coronary intervention; Rotational atherectomy.

Publication types

  • Review

MeSH terms

  • Atherectomy, Coronary* / methods
  • Coronary Angiography / methods
  • Coronary Artery Disease* / diagnosis
  • Coronary Artery Disease* / surgery
  • Drug-Eluting Stents*
  • Humans
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Treatment Outcome
  • Vascular Calcification* / diagnosis
  • Vascular Calcification* / surgery