Aims

Firstly, we aimed to assess the procedural success of rotational atherectomy in chronic total coronary occlusion; secondly, to explore the clinical in-hospital outcomes and results after a one-year follow-up.

Methods and results

Between 2015 and 2019, patients undergoing percutaneous coronary intervention in chronic total occlusions (CTO PCI) were retrospectively included into the hospital database. The primary endpoint was procedural success. Secondary endpoints were in-hospital and 1-year major adverse cardiovascular event (MACCE) rates. During the study period of 5 years 2.789 patients underwent CTO PCI. Patients treated with RA (n=193, 6.92%) had a significantly higher procedural success (93.26% vs 85.10%, p = 0.0002) compared with those treated without RA (n=2596, 93.08%). Despite a significantly higher rate of pericardiocentesis (3.11% vs 0.50%, p = 0.0013) in the RA group, the in-hospital and one-year MACCE rate was similar in both groups (4.15% vs 2.77%, p = 0.2612; 18.65% vs 16.72%, p = 0.485). 

Conclusion: RA is associated with higher procedural success during CTO PCI, but has higher risks for pericardial tamponade than CTO PCI without the need for RA. Nevertheless, in-hospital and one-year MACCE rate did not differ in-between both groups.

Keywords: PCI, chronic total occlusion, CTO, rotational atherectomy, coronary artery disease

Condensed abstract:

In a large CTO cohort from a high-volume center, the revascularization of the CTO showed a higher procedural success when performed with RA. We found no significant differences in terms of MACCE, both in-hospital and at one-year, between patients treated with RA or not for CTO PCI.