coronary rotational atherectomy elective vs. bailout in severely calcified lesions and chronic renal failure

Conditions: Coronary Artery Disease; Chronic Renal Failure

Summary: the current role of the rotational atherectomy is for non-dilatable coronary lesions and for severely calcified lesions that may interfere with optimal stent expansion. severely calcified coronary lesions are associated with worse outcomes. in this regard, chronic kidney disease is associated with severely calcified coronary arteries. some evidence suggests that elective rotational atherectomy used by experienced operators can be safe and effective, minimizing time and complications for patients with heavily calcified lesions. however, there is no direct randomized comparison between rotational atherectomy and angioplasty alone in the setting of chronic renal failure and with intravascular ultrasound assessment for detecting severely calcified coronary arteries.

the current role of the rotational atherectomy is for non-dilatable coronary lesions and for severely calcified lesions that may interfere with optimal stent expansion. severely calcified coronary lesions are associated with worse outcomes. in this regard, chronic kidney disease is associated with severely calcified coronary arteries. some evidence suggests that elective rotational atherectomy used by experienced operators can be safe and effective, minimizing time and complications for patients with heavily calcified lesions. however, there is no direct randomized comparison between rotational atherectomy and angioplasty alone in the setting of chronic renal failure and with intravascular ultrasound assessment for detecting severely calcified coronary arteries. the aim of this study is to compare the healthcare cost analysis between elective atherectomy and conventional atherectomy (bailout). the secondary endpoints were stent placement success (defined as expansion with \<20% residual stenosis assessed by intravascular ultrasound and timi 3 flow without crossover or stent failure), procedure time, radiation exposure, periprocedural and in-hospital complications, and major cardiovascular adverse events at medium-term follow-up.

Eligibility criteria:
inclusion criteria: * patients \>18 years. * glomerular filtration rate (gfr) \<60 ml/min/1.73 m2 for 3 months or more * stenosis ≥70% in a coronary artery with a diameter ≥2,5 mm. * severe angiographic calcification (affecting both sides of the arterial lumen) * any clinical scenario except acute myocardial infarction in the first seven days of evolution. * native coronary vessel or bypass graft. exclusion criteria: * absence of informed consent. * acute myocardial infarction in the first 7 days of evolution. * lesion in a single patent vessel. * calcified lesions with an angulation \>60º, dissections, lesions with thrombus, and degenerated saphenous vein grafts. * hemodynamically unstable patients * patients with allergy to iodinated contrast media * patients with significant comorbidity and with a life expectancy of less than one year

Keywords: severely calcified coronary lesion rotational atherectomy chronic kidney disease intravascular ultrasound percutaneous coronary intervention