Overview
Recurrent angina after rotational atherectomy (RA) for severely calcified coronary lesions may indicate incomplete revascularization or procedural complications. RA is a technique used during percutaneous coronary intervention (PCI) to debulk calcified plaque 13.Diagnosis
Management
Rotational atherectomy followed by cutting balloon angioplasty before stenting demonstrated similar safety and efficacy regarding major adverse cardiovascular events (MACE) compared to RA with bare balloons 1.
Planned RA, compared to bailout RA, was associated with shorter procedural times, less contrast volume, fewer coronary dissections, and fewer stents used 3.
Fractional flow reserve (FFR)-guided revascularization was associated with lower rates of all-cause death, myocardial infarction, and MACE compared to angiography-guided revascularization in a meta-analysis of observational studies 2. However, when only randomized controlled trials (RCTs) were considered, no significant difference was observed for any endpoints 2.Special Populations
Key Recommendations
Rotational atherectomy followed by cutting balloon angioplasty before stenting is a viable strategy for severely calcified lesions, with outcomes similar to rotational atherectomy with bare balloons 1. (Evidence: Moderate)
Planned rotational atherectomy is associated with improved procedural efficiency and reduced complications compared to bailout rotational atherectomy 3. (Evidence: Moderate)
Fractional flow reserve-guided revascularization may reduce adverse cardiovascular outcomes compared to angiography-guided revascularization, particularly in settings with lower rates of revascularization and acute coronary syndromes 2. (Evidence: Moderate)References
1 Altobaishat O, Abouzid M, Tanashat M, Amin AM, Turkmani M, Abuelazm M. Rotational atherectomy with cutting balloon before stenting in severely calcified coronary lesions: a meta-analysis. Future cardiology 2024. link
2 Mangiacapra F, Paolucci L, Johnson NP, Viscusi MM, Ussia GP, Grigioni F et al.. Systematic review and meta-analysis of randomized and nonrandomized studies on fractional flow reserve-guided revascularization. Revista espanola de cardiologia (English ed.) 2024. link
3 Schwarz K, Lovatt S, Borovac JA, Parasuraman S, Kwok CS. Planned Versus Bailout Rotational Atherectomy: A Systematic Review and Meta-Analysis. Cardiovascular revascularization medicine : including molecular interventions 2022. link