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AIMS:


This study aims to evaluate the early and late incidence of complications of rotational atherectomy for complex and extremely calcified lesions with DES implantation. 

METHODS AND RESULTS:


A cohort of 138 subjects (71±10y, 63%male, BMI:26.9±4.6, creatinine clearance: 69.6±38.0mg/dl, LVEF: 59±14%), were followed after rotational atherectomy between 2012 - 2016. The most frequent risk factors observed were hypertension (87%), dyslipidemia (69%), diabetes (44%) and sedentary lifestyle (72%). 244 vessels were treated, of which 179 vessels with the aid of rotational atherectomy (burr size 1.75mm in 46% of the procedures, Relation burr size/vessel was 0.6:1). In all, 308 Everolimus eluting stents were implanted (2.28±2.0 stents/patient). Vessels stenosis: 86±11%, 42.6±23.8mm in extension, 63% presented multivessel disease, Average Syntax score data: 22.4±11.5, with 18% of individuals classified as high risk, 24% as intermediate risk and 58% as low risk, Arterial access: Femoral in 76.8% of cases, radial in 22.5% and ulnar in 0.7% of cases. 70% of the subjects performed rotational atherectomy in 1 vessel, 28% in 2 and 2% in 3 vessels. Lesion transposition was achieved in 99% of the cases, Angiographic success with stent implantation in 98% of vessels. The most common approach was performed in the left anterior descending artery (58% of cases). The hospital length of stay was 2.6±3.7days, and the late follow-up was performed by phone calls within four years of the procedure. In-hospital events were observed in 20 (14.4%) of the individuals. In-hospital major adverse cardiovascular events (MACE) were observed in 10 subjects (7.2%), with 6 deaths (in-hospital mortality: 4.3%). Minor events occurred in 10 subjects (7.2%). The following events were observed: Myocardial infarction 3 (2.1%), Large dissections 6/179 (3.4%) in vessels submitted to rotational atherectomy and adequately treated with stents, Arterial perforations (3/244), Peri-procedure stroke (1/138), Pneumonia (1/138), Rotawire fracture with buried tip between stent and vessel (1/138), Hematoma at the access site (3/138), Renal failure exacerbation (2/138), Burr entrapment (2/138). Regarding phone contact, 60% (83/138) of individuals or their families were successfully contacted. The late mortality rate within 4 years observed through phone was 14.5% (12/83 individuals), being renal failure the major cause of death 4/12 patients (33.3%). 97% of patients maintained regular use of DAPT. Only 42% reported regular exercise. Disconfort/chest pain were reported by 13% of the individuals. The total mortality rate found in 4 years was 13% (18/138), including in-hospital and out-of-hospital late events.

CONCLUSION:


Rotational atherectomy and DES in heavy calcified and long lesions presented a low occurrence of MACE in immediate and late follow up, leading to a high success rate of appropriate stent implantation (98%) in lesions that otherwise might not be feasible.