Rotational atherectomy in CTO lesions: too risky? Outcome of rotational atherectomy in CTO lesions compared to non-CTO lesions.

Aims: The aim of this study was to determine the feasibility of rotational atherectomy (RA) in chronic total occlusion (CTO) PCI and compare the success and complication rates of RA in CTO lesions versus non-occluded lesions. Data on RA in CTO are rare and it is unknown how procedural success and risk of RA in CTO lesions compare to RA in non-CTO lesions.

Methods And Results: RA was performed in 392 out of 17,919 PCI procedures (2.2% of the PCI cohort) and classified as RA CTO (n=75) and RA non-CTO (n=317). Procedural success and MACCE in both groups were assessed by two investigators. All RA procedures were analysed for dissections prior to RA, which were defined according to the NHLBI classification. Baseline characteristics were not significantly different in the two groups but, in RA CTO, lesion type was more complex (p<0.001), stented segments were longer (35.0±22.7 vs. 46.0±24.8 mm, p<0.001) and mean burr size was smaller (1.61±0.17 vs. 1.49±0.18 mm, p<0.001). Procedural success and complications were not different (RA non-CTO 96.2% and RA CTO 94.7%, RA non-CTO 2.5% and RA CTO 4.0%, respectively). RA performed in dissection planes had a 100% procedure success rate in CTO and a 92% success rate in non-CTO.

Conclusions: RA in CTO is as safe and as effective as RA in non-CTO. The presence of dissections prior to RA in CTO lesions as well as in non-CTO lesions does not seem to have a negative impact on outcome.