Kidney disease, diabetes, and diameter stenosis predict Rotablation bailout in modified balloon application for severely calcified coronary lesions

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2024-09-02 DOI:10.1002/ccd.31181

Dominik Felbel MD, Ali Fattom, Isabella Fechter, Michael Paukovitsch MD, Tilman Stephan MD, Matthias Gröger MD, Mirjam Keßler MD, Leonhard Schneider MD, Johannes Mörike MD, Birgid Gonska MD, Armin Imhof MD, Wolfgang Rottbauer MD, Dominik Buckert MD, Sinisa Markovic MD

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Abstract

Background

Modified balloon (MB) treatment in severely calcified coronary artery lesions is an established technique. However, some lesions require Rotablation (RA) as bailout strategy.

Aims

This study aimed to assess predictors of switch from MB to RA and its impact on procedural and midterm outcomes.

Methods

Four hundred and eighty-three consecutive patients were included undergoing MB treatment (n = 204) with a scoring or cutting balloon, or upfront RA treatment (n = 279) serving as control cohort. Strategy switch from MB to RA was performed in 19 of 204 patients. Procedural success was defined as successful stent implantation and TIMI III flow.

Results

In the MB cohort, median age was 72 [63−78] years, 75.5% were male and 42.1% had acute coronary syndrome. Procedure success was achieved in 89.4% of the switch group versus 98.4% of the MB only group (p < 0.001) and in 96.4% of the RA cohort. In the switch group, periprocedural complications (31.6% vs. 8.1% vs. 11.8%, p = 0.007), radiation dose (149 [126–252] vs. 59 [30–97] vs. 102 [59–156] Gcm²; p < 0.001) and contrast volume (250 [190–250] vs. 190 [150–250] vs. 195 [190–-250] mL; p < 0.001) were significantly higher. Diabetes (OR 3.8, 95% CI 1.1–13.9, p = 0.042), chronic kidney disease stage 4 or 5 (OR 19.0, 95% CI 3.3–108.6, p < 0.001) and pronounced calcification resulting in higher angiographic diameter stenosis (OR 1.13, 95% CI 1.1–1.2, p = 0.001) independently predicted strategy switch. Midterm results were not affected by strategy switch regarding 1-year target lesion revascularization rates (86% vs. 89% vs. 89%; log-rank p = 0.95).

Conclusion

Primary RA strategy might be considered in patients with severely calcified coronary artery lesions with high angiographic diameter stenosis, diabetes or impaired renal function due to increased periprocedural complication rates, radiation dose, and contrast volume following strategy switch.

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肾脏疾病、糖尿病和直径狭窄可预测改良球囊应用于严重钙化冠状动脉病变时的旋转消融保送。

背景：改良球囊（MB）治疗严重钙化的冠状动脉病变是一项成熟的技术。目的：本研究旨在评估从 MB 转为 RA 的预测因素及其对手术和中期结果的影响：研究纳入了483名连续接受MB治疗（n = 204）的患者，这些患者均使用刻线球囊或切割球囊，或作为对照组的前期RA治疗（n = 279）。204 例患者中有 19 例从 MB 转为 RA。手术成功定义为支架植入成功和 TIMI III 血流：在 MB 队列中，中位年龄为 72 [63-78] 岁，75.5% 为男性，42.1% 患有急性冠状动脉综合征。89.4%的转换组获得了手术成功，而仅 MB 组的成功率为 98.4%（P 2；P 结论：对于严重钙化冠状动脉病变、血管造影直径狭窄程度高、糖尿病或肾功能受损的患者，由于转换策略后围手术并发症发生率、放射剂量和造影剂用量增加，可考虑采用初级 RA 策略。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.