Coronary stenting after rotational atherectomy in calcified and complex lesions: Angiographic and clinical follow-up results

Background: Treatment of calcified (in contrast to simple) lesions with PTCA has been associated with a lower success rate and more procedural complications. Rotablation can improve acute results, but the high restenosis rate remains a problem. The purpose of this study was to evaluate the clinical and angiographic outcome of patients with complex and calcified lesions treated with a combination of rotablation anti stenting. Methods and Results: Seventy-five consecutive patients with 106 lesions had rotablation prior to coronary stenting. Intravascular ultrasound-guided stenting was used without subsequent anticoagulation in 93% of patients. Procedural success was achieved in 93.4% of lesions. Acute stent thrombosis occurred in two lesions (1.9%), and subacute stent thrombosis in one lesion (0.9%). Angiographic follow-up was performed in 82.5% of lesions at 4.6±1.9 months with an angiographic restenosis rate of 22.5%. Clinical follow-up was performed in all patients at 6.4±3 months; target lesion revascularization was needed in 18% of lesions. Q-wave myocardial infarction occurred in 1.3%, coronary bypass surgery in 4.0%, and death in 1.3%. Conclusions: Optimal coronary stenting after rotablation in calcified and complex lesions can be performed with a high success rate, an acceptable rate of procedural complications, and a low rate of stent thrombosis. This approach was associated with a low incidence of angiographic restenosis compared with results usually obtained with other intervention strategies in calcified and complex lesion subsets.