Rotational atherectomy with cutting balloon before stenting in severely calcified coronary lesions: a meta-analysis

Background: Rotational atherectomy (RA) has been proven to treat coronary artery calcification (CAC) during percutaneous coronary intervention (PCI).

Purpose: This study evaluates the safety and efficacy of RA followed by cutting balloon angioplasty (ROTACUT) before stent placement in CAC.

Methods: A systematic review and meta-analysis of randomized controlled trials and observational studies was conducted. PubMed, Web of Science, Scopus, and Cochrane were searched through January 2024. We used Stata version 17 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD), with a 95% confidence interval (CI).

Results: Eight studies with 846 patients were included. There was no significant difference between ROTACUT and RA + bare balloons in major adverse cardiovascular events (MACE) (RR:0.60; 95%CI [0.31,1.16], p = 0.13), cardiac death (RR:1.32; 95%CI [0.42,4.14], p = 0.64), target vessel revascularization (TVR) (RR:1.89; 95%CI [0.40,8.84], p = 0.42), target lesion revascularization (TLR) (RR:0.83; 95%CI [0.39,1.79], p = 0.64), procedural duration (MD:0.78; 95%CI [-4.68,6.24], p = 0.78), stent thrombosis (RR:0.81; 95%CI [0.22,2.95], p = 0.75), and any procedure-related complications (RR:0.86; 95%CI [0.42,1.75], p = 0.68).

Conclusion: ROTACUT and RA + bare balloons demonstrated similar efficacy and safety profiles regarding MACE, cardiac death, TVR, TLR, procedural duration, stent thrombosis, and all safety outcomes.