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TCT-230 Rotational Atherectomy vs Orbital Atherectomy in Calcified Coronary Artery Disease: A Contemporary Retrospective Comparative Analysis (ROCC study)
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
ATHERECTOMY (EXCLUDING THROMBECTOMY)
Abstract nos: 228 - 241 TCT-228 Rotational atherectomy of malapposed, undilatable coronary stents: fact or fiction? Istvan F. Edes,1 Zoltan Ruzsa,2 György Szabó,3 Árpád Lux,4 László Gellér,5 Levente Molnar,6 Fanni Nowotta,7 Ágota Hajas,8 Dávid Becker,9 Béla Merkely10 1 Semmelweis University Heart and Vascular Center, Budapest, Hungary; 2 Semmelweis University, Budapest, Hungary; 3Gottsegen György Országos Kardiológiai Intézet, Budapest, Hungary; 4Semmelweis University, Budapest, Hungary; 5Semmelweis University Heart and Vascular Center; 6Heart Center, Budapest, Hungary; 7Semmelweis University Heart and Vascular Center; 8Semmelweis University Heart and Vascular Center; 9Semmelweis University Heart and Vascular Center; 10 Semmelweis University Heart and Vascular Center, Budapest, Hungary BACKGROUND Coronary stents, forcefully implanted into calcific and/or fibrotic lesions often fail to fully expand, even after high pressure post-dilation. These malapposed, crippled metallic implants refarctory to further balloon manipulation pose a frightning scenario for practitioners. As a last resort method the use of rotational atherectomy (RA) on such otherwise non-salvageable metallic stents: stentablation (SA) has been anecdotally reported. Our aim was to examine procedural viability and mid-term outcomes following SA procedures and convey important procedural pointers for practitioners encountering such situations. METHODS Data on twelve SA subjects were analysed. Primary endpoint was procedural success: effective rotational ablation of the malapposed stent and successful implantation of a new device, thus restoring adequate coronary anatomy. Major adverse cardiac events (MACE) and all cause death at six months following the index procedure was also examined as a secondary endpoint. The Rotalink PlusTM system was utilized to carry out the procedures. Maximum turbine speed was applied and a step-wise modulation in burr diameter was carried out. After succesful burr passage upsized noncompliant balloon dilations were performed and novel stents implanted, covering the entire ablated area. RESULTS All twelve patients underwent successful SA and novel stent implantation, with sufficient salvage of coronary anatomy (residual stenosis <30%). At six months follow-up however, MACE amounted to a very high 50%, all-cause mortality to an equally disappointing 25% in the inspected subjects. CONCLUSION We have found that although feasible as an acute salvage option, SA distinctively increases post-procedure mid-term MACE and mortality rates. This puts emphasis on the importance of avoiding eventual SA situations, underlining the importance of ample lesion preparation prior to stent implantation. Yet, when no other option is left however, SA can save the subject from an early thrombosis of the malapposed device or even from a conversion into acute coronary surgery. CATEGORIES CORONARY: Atherectomy (excluding thrombectomy) TCT-229 Safety and Efficacy of Rotational Atherectomy for the Treatment of Undilatable Underexpanded Stents Implanted in Calcific Lesions Luca Angelo Ferri,1 Richard Jabbour,2 francesco giannini,3 Susanna Benincasa,4 Damiano Regazzoli,5 Marco Ancona,6 andrea aurelio,7 antonio Mangieri,8 Matteo Montorfano,9 Mauro Carlino,10 Alaide Chieffo,11 Antonio Colombo,12 Azeem Latib13 1 San Raffaele Hospital / Vita-Salute University, Milan, Milan, Italy; 2 Unknown, London, United Kingdom; 3Interventional Cardiology institute San Raffaele Hospital, Soverato, Reggio Calabria, Italy; 4 Ospedale S. Raffaele, MILANO, Milan, Italy; 5San Raffaele Hospital; 6 San Raffaele Scientific Insitute, milan, Milan, Italy; 7San Raffaele Hospital - Milan, Taranto, Bari, Italy; 8San Raffaele Hospital, Milan, Milan, Italy; 9San Raffaele Hospital, Milan, Italy; 10San Raffaele Hospital, Milan, Milan, Italy; 11San Raffaele Scientific Institute, Milan, Italy; 12San Raffaele Scientific Institute, Milan, Italy; 13EMO-GVM Centro Cuore Columbus, Milan, Italy
B93
BACKGROUND Coronary stent underexpansion is a known risk factor for in-stent restenosis and stent thrombosis. There are limited options once non-compliant balloons (NCB) have failed to achieve optimal stent expansion. Excimer Laser Coronary Angioplasty with contrast medium injection (ELCA) is one possibility, but not readily available. Rotational atherectomy (RA) is an alternative, but has been described only in single case reports and concerns exist regarding safety. METHODS All consecutive patients undergoing RA for symptomatic in-stent restenosis due to stent underexpansion resistant to NCB postdilatation between January 2005 and December 2015 were analyzed. RESULTS A total of 16 patients underwent treatment during the study period: the clinical indication was effort angina with inducible ischemia in 14 cases (87.5%) and acute coronary syndrome in 2 cases (12.5%); the mean age of the patients treated was 6513.8 years and the mean ejection fraction of 49.78.9%. The vessel treated was left anterior descending artery in 7 cases (43.8%), left circumflex in 4 cases (25%), right coronary artery in 5 cases (31.2%). The mean size of the burr used was 1.7 0.2mm with a mean burr size/lumen ratio of 0.6 0.06, rotating at the mean speed of 171.2 5.8rpm. The procedure was successful in 14 cases (87.5%): after RA full NCB expansion was achieved in all cases and the target lesion was treated with a second generation drug eluting stent in 13 cases, 1 case being treated with drug eluting balloon. The mean post-procedural minimal lumen diameter increased by 2.30.8mm and percentage diameter stenosis decreased from 82.17 17.2% to 11.9 9.1%. Intraprocedural complications occurred in 2 patients (burr entrapment successfully managed percutaneously and periprocedural myocardial infarction). At 1-year follow-up, the incidence of target lesion revascularisation was 13.3% (2 out of 15 patients), and 1 patient died from noncardiac death. CONCLUSION In this first reported case series, RA seems an effective and safe treatment option for symptomatic stent underexpansion resistant to balloon dilatation. CATEGORIES CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP) TCT-230 Rotational Atherectomy vs Orbital Atherectomy in Calcified Coronary Artery Disease: A Contemporary Retrospective Comparative Analysis (ROCC study) Allen McGrew,1 Manjeet Singh,2 Jeffery Stahl,3 Jessica Yoos,4 Kintur Sanghvi5 1 Deborah Heart and Lung Center, Mount Laurel, New Jersey, United States; 2Santa Casa de Belo Horizonte; 3kingstron bio; 4Capricor Inc; 5 Deborah Heart & Lung Center, Princeton, New Jersey, United States BACKGROUND Severe coronary calcification adversely influences success of percutaneous coronary intervention. Lesion modification with Rotational atherectomy (RA) (Boston Scientific) and Orbital atherectomy (OA) (Diamondback 360Ò (CSI)) help facilitate stent delivery and improve clinical outcomes. We sought to identify differences in safety and efficacy of RA and OA in treatment of calcified coronary lesions. METHODS Between June 2010 and July 2015, all patients at a single center who had attempted treatment with RA or OA were retrospectively evaluated. Demographic, procedural, clinical data and six-month follow-up data were collected by chart review. Two interventional cardiologists independently reviewed each cineangiography to record lesion traits and angiographic outcomes. RESULTS Intention to treat analysis was performed for 127 lesions in OA group and 147 in RA group. Baseline demographic and clinical data were comparable between groups. The RA group had significantly higher degrees of calcification and stenosis [Fig 1A]. OA group had more frequent radial access, smaller sheaths and guideliners usage. The primary endpoint of procedural success (successful atherectomy & stent deployment with < 50% residual stenosis) was similar between groups [Fig 1B]. TIMI flow post atherectomy was similar. While composite post-atherectomy procedural complications were higher in OA group, no statistically significant differences were observed in clinical complications, MACE rate, or angina free survival at 6 months follow up [Fig 1B].
B94
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
All procedures
Radial
Femoral
Radial vs Femoral
(n[618)
(n[500)
(n[116)
P-value
Coronary artery dissection
12 (1.9)
10 (2.0)
2 (1.7)
NS
No flow/slow flow
2 (0.3)
2 (0.4)
0 (0)
NS
Major vessel occlusion
6 (1.0)
6 (1.2)
0 (0)
NS
Side branch occlusion
8 (1.3)
8 (1.6)
0 (0)
NS
Procedural complications n (%)
Bleeding Coronary artery perforation
13 (2.1)
9 (1.8)
4 (3.4)
NS
Cardiac tamponade
5 (0.8)
2 (0.6)
3 (2.6)
NS
BARC 2
25 (4.0)
12 (2.4)
13 (11.2)
<0.001
Cardiogenic shock requiring IABP
4 (0.6)
4 (0.8)
0 (0)
NS
Bradycardia requiring TPL
16 (2.6)
13 (2.4)
3 (2.6)
NS
Cardiac arrest (not resulting in death)
3 (0.5)
2 (0.4)
1 (0.9)
NS
In-lab death
4 (0.6)
4 (0.8)
0 (0)
NS
3 (0.5)
3 (0.6)
0 (0)
ACS presentation In-hospital complications n (%)
CONCLUSION Orbital atherectomy and Rotational Atherectomy in contemporary practice are equally safe and effective for plaque modification in significantly calcified coronary artery lesions with high success rates. CATEGORIES CORONARY: Atherectomy (excluding thrombectomy)
Renal failure
2 (0.3)
1 (0.2)
1 (0.9)
NS
Stroke/TIA
4 (0.6)
2 (0.4)
1 (0.9)
NS
Re-intervention
1 (0.1)
1 (0.2)
0 (0)
NS
18 (2.9)
14 (2.8)
4 (3.4)
NS
14 (2.3)
11 (2.2)
3 (2.6)
-
27 (4.4)
22 (4.4)
5 (4.3)
NS
Mortality n (%) 7 days ACS presentation
TCT-231 The Glasgow Trans-radial Rotablation Registry – A Retrospective Analysis of High-speed Rotational Atherectomy Alice Jackson,1 Kieran Docherty,2 Jim Christie,3 Mitchell Lindsay,4 Keith Oldroyd,5 Stuart Watkins,6 Aadil Shaukat,7 Colin Berry,8 Keith Robertson,9 Richard Good,10 Mark Petrie,11 Stuart Hood,12 Andrew Davie,13 Hany Eteiba,14 Margaret McEntegart,15 John Paul Rocchiccioli16 1 Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum; 2 Department of Cardiology and Angiology, Center of Internal Medicine, Klinikum Ernst von Bergmann, Potsdam, Germany, Glasgow, United Kingdom; 3Penn State University; 4Golden Jubilee National Hospital Scotland; 5West of Scotland Regional Heart and Lung Centre, Glasgow, United Kingdom; 6Golden Jubilee National Hospital, Glasgow, United Kingdom; 7Gri, Glasgow, United Kingdom; 8Golden Jubilee National Hospital, Glasgow, United Kingdom; 9NHS, Glasgow, United Kingdom; 10 Golden Jubilee National Hospital, Glasgow, United Kingdom; 11 Unknown, glasgow, United Kingdom; 12University of Minnesota; 13 Unknown, Glasgow, United Kingdom; 14Golden Jubilee National Hospital, Clydebank, United Kingdom; 15Golden Jubilee National Hospital, Glasgow, United Kingdom; 16Golden Jubilee National Hospital, Glasgow, United Kingdom BACKGROUND High-speed rotational atherectomy (HSRA) is an adjunctive treatment of calcific coronary disease. Historically, HSRA is associated with higher complication rates. Contemporary UK data show trans-femoral access (TFA) is still favoured over trans-radial access (TRA). The aim of this study was to describe outcomes of HSRA in a high-volume, largely TRA centre. METHODS We retrospectively identified consecutive patients who underwent HSRA percutaneous coronary intervention (PCI) from 08/ 2010 to 08/2015 in our regional centre (2.2million population). Data were collected from the PCI database and patient records. RESULTS 601 patients underwent 618 HSRA PCI in 5 years, representing 4.7% (618/13198) of all PCI. 372 (61.9%) were male, mean age 73. 156 (26.0%) were aged 80. 204 (33.9%) had diabetes, 415 (69.1%) hypertension, 91 (15.1%) a history of stroke/TIA, 18 (3.0%) on renal dialysis and 77 (12.8%) previous CABG. 500 (80.9%) procedures were performed using TRA. Over half (53.7%) were performed in acute coronary syndrome (ACS) and 29 (4.6%) in STEMI. Pre-emptive intraaortic balloon pump or temporary pacing was used in 7 (1.1%) and 2 (0.3%) cases respectively. A GP2b3a inhibitor was used in 86 (13.9%). The most commonly treated vessel was the left anterior descending (44.8%), unprotected left main in 128 (20.7%) and 2 vessels in 80 (12.9%). 1.5mm and 1.75mm burrs were used in 344 (55.7%) and 195 (31.6%) cases respectively. Serious bleeding (BARC 2) occurred in 25 (4.0%) and was significantly higher in TFA procedures (Table 1). Procedural, 7-day, 30-day and 6-month mortality rates were 0.6%, 2.9%, 4.4% and 8.6% respectively, predominantly in those with an ACS. (Table 1).
30 days ACS presentation 6 months ACS presentation
23 (3.7)
19 (3.8)
4 (3.4)
-
53 (8.6)
42 (8.4)
11 (9.5)
NS
43 (7.0)
35 (7.0)
8 (6.9)
-
CONCLUSION Our study demonstrates the feasibility and safety of HSRA PCI in complex calcific coronary disease using the trans-radial approach, with significant reductions in major bleeding compared with trans-femoral procedures. CATEGORIES CORONARY: Atherectomy (excluding thrombectomy) TCT-232 The Glasgow MRI Rotational Atherectomy Study (GlaMoRoS): HSRA PCI is associated with a low rate of peri-procedural MI and a significant improvement in ischemic burden. David Corcoran,1 Colin Berry,2 Guillaume Clerfond,3 David Carrick,4 Kenneth Mangion,5 Barry Hennigan,6 John Paul Rocchiccioli,7 Aleksandra Radjenovic,8 Mitchell Lindsay,9 Hany Eteiba,10 Keith Oldroyd,11 Margaret McEntegart12 1 The Prince Charles Hospital, Glasgow, United Kingdom; 2Golden Jubilee National Hospital, Glasgow, United Kingdom; 3The Prince of Wales Hospital; 4Golden Jubilee National Hospital; 5 Universitätsklinikum Regensburg - Herz-, Thorax- und herznahe Gefäßchirurgie Fachbereich Kardiotechnik; 6University of Glasgow, Glasgow, United Kingdom; 7Golden Jubilee National Hospital, Glasgow, United Kingdom; 8Hospital San Borja Arriaran, Glasgow, United Kingdom; 9Golden Jubilee National Hospital - Scotland; 10 Golden Jubilee National Hospital, Clydebank, United Kingdom; 11 West of Scotland Regional Heart and Lung Centre, Glasgow, United Kingdom; 12Golden Jubilee National Hospital, Glasgow, United Kingdom BACKGROUND Percutaneous coronary intervention (PCI) with adjunctive high speed rotational atherectomy (HSRA) is commonly used to treat complex and calcified coronary artery stenoses. Theoretically, HSRA may have deleterious effects on the coronary microcirculation and result in peri-procedural myocardial infarction (Type 4a MI). We studied the effects of HSRA PCI using serial multi-parametric cardiac magnetic resonance imaging (CMR). METHODS We prospectively enrolled 58 patients undergoing elective HSRA PCI and performed multi-parametric CMR at 3 time-points: before HSRA (T1), <7 days post-HSRA (T2), and 6 months post-HSRA (T3). The CMR protocol comprised global and regional LV function assessment, adenosine stress perfusion, and late gadolinium enhancement (LGE) (1.5 Tesla MAGNETOM Avanto, Siemens Healthcare, Germany). Myocardial perfusion abnormalities were assessed qualitatively. High-sensitivity cardiac troponin (hsTn) was measured
ATHERECTOMY (EXCLUDING THROMBECTOMY)
Abstract nos: 228 - 241 TCT-228 Rotational atherectomy of malapposed, undilatable coronary stents: fact or fiction? Istvan F. Edes,1 Zoltan Ruzsa,2 György Szabó,3 Árpád Lux,4 László Gellér,5 Levente Molnar,6 Fanni Nowotta,7 Ágota Hajas,8 Dávid Becker,9 Béla Merkely10 1 Semmelweis University Heart and Vascular Center, Budapest, Hungary; 2 Semmelweis University, Budapest, Hungary; 3Gottsegen György Országos Kardiológiai Intézet, Budapest, Hungary; 4Semmelweis University, Budapest, Hungary; 5Semmelweis University Heart and Vascular Center; 6Heart Center, Budapest, Hungary; 7Semmelweis University Heart and Vascular Center; 8Semmelweis University Heart and Vascular Center; 9Semmelweis University Heart and Vascular Center; 10 Semmelweis University Heart and Vascular Center, Budapest, Hungary BACKGROUND Coronary stents, forcefully implanted into calcific and/or fibrotic lesions often fail to fully expand, even after high pressure post-dilation. These malapposed, crippled metallic implants refarctory to further balloon manipulation pose a frightning scenario for practitioners. As a last resort method the use of rotational atherectomy (RA) on such otherwise non-salvageable metallic stents: stentablation (SA) has been anecdotally reported. Our aim was to examine procedural viability and mid-term outcomes following SA procedures and convey important procedural pointers for practitioners encountering such situations. METHODS Data on twelve SA subjects were analysed. Primary endpoint was procedural success: effective rotational ablation of the malapposed stent and successful implantation of a new device, thus restoring adequate coronary anatomy. Major adverse cardiac events (MACE) and all cause death at six months following the index procedure was also examined as a secondary endpoint. The Rotalink PlusTM system was utilized to carry out the procedures. Maximum turbine speed was applied and a step-wise modulation in burr diameter was carried out. After succesful burr passage upsized noncompliant balloon dilations were performed and novel stents implanted, covering the entire ablated area. RESULTS All twelve patients underwent successful SA and novel stent implantation, with sufficient salvage of coronary anatomy (residual stenosis <30%). At six months follow-up however, MACE amounted to a very high 50%, all-cause mortality to an equally disappointing 25% in the inspected subjects. CONCLUSION We have found that although feasible as an acute salvage option, SA distinctively increases post-procedure mid-term MACE and mortality rates. This puts emphasis on the importance of avoiding eventual SA situations, underlining the importance of ample lesion preparation prior to stent implantation. Yet, when no other option is left however, SA can save the subject from an early thrombosis of the malapposed device or even from a conversion into acute coronary surgery. CATEGORIES CORONARY: Atherectomy (excluding thrombectomy) TCT-229 Safety and Efficacy of Rotational Atherectomy for the Treatment of Undilatable Underexpanded Stents Implanted in Calcific Lesions Luca Angelo Ferri,1 Richard Jabbour,2 francesco giannini,3 Susanna Benincasa,4 Damiano Regazzoli,5 Marco Ancona,6 andrea aurelio,7 antonio Mangieri,8 Matteo Montorfano,9 Mauro Carlino,10 Alaide Chieffo,11 Antonio Colombo,12 Azeem Latib13 1 San Raffaele Hospital / Vita-Salute University, Milan, Milan, Italy; 2 Unknown, London, United Kingdom; 3Interventional Cardiology institute San Raffaele Hospital, Soverato, Reggio Calabria, Italy; 4 Ospedale S. Raffaele, MILANO, Milan, Italy; 5San Raffaele Hospital; 6 San Raffaele Scientific Insitute, milan, Milan, Italy; 7San Raffaele Hospital - Milan, Taranto, Bari, Italy; 8San Raffaele Hospital, Milan, Milan, Italy; 9San Raffaele Hospital, Milan, Italy; 10San Raffaele Hospital, Milan, Milan, Italy; 11San Raffaele Scientific Institute, Milan, Italy; 12San Raffaele Scientific Institute, Milan, Italy; 13EMO-GVM Centro Cuore Columbus, Milan, Italy
B93
BACKGROUND Coronary stent underexpansion is a known risk factor for in-stent restenosis and stent thrombosis. There are limited options once non-compliant balloons (NCB) have failed to achieve optimal stent expansion. Excimer Laser Coronary Angioplasty with contrast medium injection (ELCA) is one possibility, but not readily available. Rotational atherectomy (RA) is an alternative, but has been described only in single case reports and concerns exist regarding safety. METHODS All consecutive patients undergoing RA for symptomatic in-stent restenosis due to stent underexpansion resistant to NCB postdilatation between January 2005 and December 2015 were analyzed. RESULTS A total of 16 patients underwent treatment during the study period: the clinical indication was effort angina with inducible ischemia in 14 cases (87.5%) and acute coronary syndrome in 2 cases (12.5%); the mean age of the patients treated was 6513.8 years and the mean ejection fraction of 49.78.9%. The vessel treated was left anterior descending artery in 7 cases (43.8%), left circumflex in 4 cases (25%), right coronary artery in 5 cases (31.2%). The mean size of the burr used was 1.7 0.2mm with a mean burr size/lumen ratio of 0.6 0.06, rotating at the mean speed of 171.2 5.8rpm. The procedure was successful in 14 cases (87.5%): after RA full NCB expansion was achieved in all cases and the target lesion was treated with a second generation drug eluting stent in 13 cases, 1 case being treated with drug eluting balloon. The mean post-procedural minimal lumen diameter increased by 2.30.8mm and percentage diameter stenosis decreased from 82.17 17.2% to 11.9 9.1%. Intraprocedural complications occurred in 2 patients (burr entrapment successfully managed percutaneously and periprocedural myocardial infarction). At 1-year follow-up, the incidence of target lesion revascularisation was 13.3% (2 out of 15 patients), and 1 patient died from noncardiac death. CONCLUSION In this first reported case series, RA seems an effective and safe treatment option for symptomatic stent underexpansion resistant to balloon dilatation. CATEGORIES CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP) TCT-230 Rotational Atherectomy vs Orbital Atherectomy in Calcified Coronary Artery Disease: A Contemporary Retrospective Comparative Analysis (ROCC study) Allen McGrew,1 Manjeet Singh,2 Jeffery Stahl,3 Jessica Yoos,4 Kintur Sanghvi5 1 Deborah Heart and Lung Center, Mount Laurel, New Jersey, United States; 2Santa Casa de Belo Horizonte; 3kingstron bio; 4Capricor Inc; 5 Deborah Heart & Lung Center, Princeton, New Jersey, United States BACKGROUND Severe coronary calcification adversely influences success of percutaneous coronary intervention. Lesion modification with Rotational atherectomy (RA) (Boston Scientific) and Orbital atherectomy (OA) (Diamondback 360Ò (CSI)) help facilitate stent delivery and improve clinical outcomes. We sought to identify differences in safety and efficacy of RA and OA in treatment of calcified coronary lesions. METHODS Between June 2010 and July 2015, all patients at a single center who had attempted treatment with RA or OA were retrospectively evaluated. Demographic, procedural, clinical data and six-month follow-up data were collected by chart review. Two interventional cardiologists independently reviewed each cineangiography to record lesion traits and angiographic outcomes. RESULTS Intention to treat analysis was performed for 127 lesions in OA group and 147 in RA group. Baseline demographic and clinical data were comparable between groups. The RA group had significantly higher degrees of calcification and stenosis [Fig 1A]. OA group had more frequent radial access, smaller sheaths and guideliners usage. The primary endpoint of procedural success (successful atherectomy & stent deployment with < 50% residual stenosis) was similar between groups [Fig 1B]. TIMI flow post atherectomy was similar. While composite post-atherectomy procedural complications were higher in OA group, no statistically significant differences were observed in clinical complications, MACE rate, or angina free survival at 6 months follow up [Fig 1B].
B94
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
All procedures
Radial
Femoral
Radial vs Femoral
(n[618)
(n[500)
(n[116)
P-value
Coronary artery dissection
12 (1.9)
10 (2.0)
2 (1.7)
NS
No flow/slow flow
2 (0.3)
2 (0.4)
0 (0)
NS
Major vessel occlusion
6 (1.0)
6 (1.2)
0 (0)
NS
Side branch occlusion
8 (1.3)
8 (1.6)
0 (0)
NS
Procedural complications n (%)
Bleeding Coronary artery perforation
13 (2.1)
9 (1.8)
4 (3.4)
NS
Cardiac tamponade
5 (0.8)
2 (0.6)
3 (2.6)
NS
BARC 2
25 (4.0)
12 (2.4)
13 (11.2)
<0.001
Cardiogenic shock requiring IABP
4 (0.6)
4 (0.8)
0 (0)
NS
Bradycardia requiring TPL
16 (2.6)
13 (2.4)
3 (2.6)
NS
Cardiac arrest (not resulting in death)
3 (0.5)
2 (0.4)
1 (0.9)
NS
In-lab death
4 (0.6)
4 (0.8)
0 (0)
NS
3 (0.5)
3 (0.6)
0 (0)
ACS presentation In-hospital complications n (%)
CONCLUSION Orbital atherectomy and Rotational Atherectomy in contemporary practice are equally safe and effective for plaque modification in significantly calcified coronary artery lesions with high success rates. CATEGORIES CORONARY: Atherectomy (excluding thrombectomy)
Renal failure
2 (0.3)
1 (0.2)
1 (0.9)
NS
Stroke/TIA
4 (0.6)
2 (0.4)
1 (0.9)
NS
Re-intervention
1 (0.1)
1 (0.2)
0 (0)
NS
18 (2.9)
14 (2.8)
4 (3.4)
NS
14 (2.3)
11 (2.2)
3 (2.6)
-
27 (4.4)
22 (4.4)
5 (4.3)
NS
Mortality n (%) 7 days ACS presentation
TCT-231 The Glasgow Trans-radial Rotablation Registry – A Retrospective Analysis of High-speed Rotational Atherectomy Alice Jackson,1 Kieran Docherty,2 Jim Christie,3 Mitchell Lindsay,4 Keith Oldroyd,5 Stuart Watkins,6 Aadil Shaukat,7 Colin Berry,8 Keith Robertson,9 Richard Good,10 Mark Petrie,11 Stuart Hood,12 Andrew Davie,13 Hany Eteiba,14 Margaret McEntegart,15 John Paul Rocchiccioli16 1 Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum; 2 Department of Cardiology and Angiology, Center of Internal Medicine, Klinikum Ernst von Bergmann, Potsdam, Germany, Glasgow, United Kingdom; 3Penn State University; 4Golden Jubilee National Hospital Scotland; 5West of Scotland Regional Heart and Lung Centre, Glasgow, United Kingdom; 6Golden Jubilee National Hospital, Glasgow, United Kingdom; 7Gri, Glasgow, United Kingdom; 8Golden Jubilee National Hospital, Glasgow, United Kingdom; 9NHS, Glasgow, United Kingdom; 10 Golden Jubilee National Hospital, Glasgow, United Kingdom; 11 Unknown, glasgow, United Kingdom; 12University of Minnesota; 13 Unknown, Glasgow, United Kingdom; 14Golden Jubilee National Hospital, Clydebank, United Kingdom; 15Golden Jubilee National Hospital, Glasgow, United Kingdom; 16Golden Jubilee National Hospital, Glasgow, United Kingdom BACKGROUND High-speed rotational atherectomy (HSRA) is an adjunctive treatment of calcific coronary disease. Historically, HSRA is associated with higher complication rates. Contemporary UK data show trans-femoral access (TFA) is still favoured over trans-radial access (TRA). The aim of this study was to describe outcomes of HSRA in a high-volume, largely TRA centre. METHODS We retrospectively identified consecutive patients who underwent HSRA percutaneous coronary intervention (PCI) from 08/ 2010 to 08/2015 in our regional centre (2.2million population). Data were collected from the PCI database and patient records. RESULTS 601 patients underwent 618 HSRA PCI in 5 years, representing 4.7% (618/13198) of all PCI. 372 (61.9%) were male, mean age 73. 156 (26.0%) were aged 80. 204 (33.9%) had diabetes, 415 (69.1%) hypertension, 91 (15.1%) a history of stroke/TIA, 18 (3.0%) on renal dialysis and 77 (12.8%) previous CABG. 500 (80.9%) procedures were performed using TRA. Over half (53.7%) were performed in acute coronary syndrome (ACS) and 29 (4.6%) in STEMI. Pre-emptive intraaortic balloon pump or temporary pacing was used in 7 (1.1%) and 2 (0.3%) cases respectively. A GP2b3a inhibitor was used in 86 (13.9%). The most commonly treated vessel was the left anterior descending (44.8%), unprotected left main in 128 (20.7%) and 2 vessels in 80 (12.9%). 1.5mm and 1.75mm burrs were used in 344 (55.7%) and 195 (31.6%) cases respectively. Serious bleeding (BARC 2) occurred in 25 (4.0%) and was significantly higher in TFA procedures (Table 1). Procedural, 7-day, 30-day and 6-month mortality rates were 0.6%, 2.9%, 4.4% and 8.6% respectively, predominantly in those with an ACS. (Table 1).
30 days ACS presentation 6 months ACS presentation
23 (3.7)
19 (3.8)
4 (3.4)
-
53 (8.6)
42 (8.4)
11 (9.5)
NS
43 (7.0)
35 (7.0)
8 (6.9)
-
CONCLUSION Our study demonstrates the feasibility and safety of HSRA PCI in complex calcific coronary disease using the trans-radial approach, with significant reductions in major bleeding compared with trans-femoral procedures. CATEGORIES CORONARY: Atherectomy (excluding thrombectomy) TCT-232 The Glasgow MRI Rotational Atherectomy Study (GlaMoRoS): HSRA PCI is associated with a low rate of peri-procedural MI and a significant improvement in ischemic burden. David Corcoran,1 Colin Berry,2 Guillaume Clerfond,3 David Carrick,4 Kenneth Mangion,5 Barry Hennigan,6 John Paul Rocchiccioli,7 Aleksandra Radjenovic,8 Mitchell Lindsay,9 Hany Eteiba,10 Keith Oldroyd,11 Margaret McEntegart12 1 The Prince Charles Hospital, Glasgow, United Kingdom; 2Golden Jubilee National Hospital, Glasgow, United Kingdom; 3The Prince of Wales Hospital; 4Golden Jubilee National Hospital; 5 Universitätsklinikum Regensburg - Herz-, Thorax- und herznahe Gefäßchirurgie Fachbereich Kardiotechnik; 6University of Glasgow, Glasgow, United Kingdom; 7Golden Jubilee National Hospital, Glasgow, United Kingdom; 8Hospital San Borja Arriaran, Glasgow, United Kingdom; 9Golden Jubilee National Hospital - Scotland; 10 Golden Jubilee National Hospital, Clydebank, United Kingdom; 11 West of Scotland Regional Heart and Lung Centre, Glasgow, United Kingdom; 12Golden Jubilee National Hospital, Glasgow, United Kingdom BACKGROUND Percutaneous coronary intervention (PCI) with adjunctive high speed rotational atherectomy (HSRA) is commonly used to treat complex and calcified coronary artery stenoses. Theoretically, HSRA may have deleterious effects on the coronary microcirculation and result in peri-procedural myocardial infarction (Type 4a MI). We studied the effects of HSRA PCI using serial multi-parametric cardiac magnetic resonance imaging (CMR). METHODS We prospectively enrolled 58 patients undergoing elective HSRA PCI and performed multi-parametric CMR at 3 time-points: before HSRA (T1), <7 days post-HSRA (T2), and 6 months post-HSRA (T3). The CMR protocol comprised global and regional LV function assessment, adenosine stress perfusion, and late gadolinium enhancement (LGE) (1.5 Tesla MAGNETOM Avanto, Siemens Healthcare, Germany). Myocardial perfusion abnormalities were assessed qualitatively. High-sensitivity cardiac troponin (hsTn) was measured