Temporal Trends and Outcomes of Rotational Atherectomy: A Single-Centre Experience

Introduction and objectives: Rotational atherectomy (RA) is widely used for the management of calcified coronary stenoses. However, there is limited data on its use, trends, and outcomes. We sought to report our twelve-year experience with RA and explore the trends and outcomes of percutaneous coronary intervention (PCI) with this device.

Methods: Our institutional PCI database was queried to identify all cases of RA-PCI performed between January 2009 and December 2020. We analysed peri-procedural outcomes and major adverse cardiovascular events (MACE) during follow-up: cardiovascular death, myocardial infarction, and target lesion revascularization.

Results: 410 procedures (2.8% of total PCI volume) in 388 patients were included. Mean age was 72.3±9.3 years, 74.0% were male, 53.6% had diabetes, and 33.8% presented with acute coronary syndrome. There was a significant increase in median SYNTAX score (p_trend=0.003) and the proportion of type B2/C lesions (p_trend=0.003). Transradial access was preferred (60.0% overall) with a growing trend over time (p_trend=0.003). Maximum burr size was <1.75 mm in 88.0% of cases (burr-to-artery ratio of 0.49±0.07). Angiographic success rate was consistently high (96.6% overall). Complications were recorded in 9.0% of procedures, with a temporal decline (p_trend=0.029). Clinical follow-up was available for 357 patients (median time of 40 months). At one year, MACE rate was 12.1%. with no significant temporal changes.

Conclusions: RA-PCI was a safe and effective procedure with a high rate of angiographic success and few complications, particularly in recent years, in line with significant technical improvements. The MACE incidence is acceptable considering the clinical risk and angiographic complexity.