Document Detail


Rotational atherectomy in resistant chronic total occlusions.
MedLine Citation:
PMID:  20839349     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To assess the application of rotational atherectomy to improving the success rate of percutaneous recanalization of chronic total occlusion (CTO).
BACKGROUND: Although the inability to cross the occlusion with a guidewire is the reason for failure in the majority of cases, one of the most frustrating situations that may occur during a recanalization procedure is when a guidewire crosses successfully but it is impossible to advance any device over the wire through the occluded segment.
METHODS: From January 2006 to October 2009, 45/648 (7%) consecutive patients with CTO resistant to recanalization by conventional techniques were treated by high-speed rotational atherectomy (Rotablator group).
RESULTS: All but two lesions were successfully crossed by Rotablator and eventually treated by stent implantation. As compared to the 603 CTO treated by conventional techniques (Conventional group), the 45 patients in the Rotablator group were older, more often female, active smokers, with chronic kidney disease and higher rate of previous surgical revascularization. The CTO in the Rotablator group had a longer duration. Peri-procedural myocardial infarction was more frequent in the Rotablator group (35% vs. 22%; P = 0.044). Coronary perforation occurred only in three patients in the Conventional group and two of these patients needed urgent surgical intervention. No patient died from either group.
CONCLUSIONS: The inability to cross a CTO with a balloon catheter occurs in approximately 7% of all CTOs that are successfully crossed with a guidewire. Rotational atherectomy is a safe and effective technique to overcome this frustrating situation.
Authors:
Paolo Pagnotta; Carlo Briguori; Ruggiero Mango; Gabriella Visconti; Amelia Focaccio; Guido Belli; Patrizia Presbitero
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  76     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-14     Completed Date:  2011-01-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  366-71     Citation Subset:  IM    
Affiliation:
Department of Cardiology, IRCCS Humanitas, Milan, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary* / adverse effects,  instrumentation
Atherectomy, Coronary* / adverse effects
Chi-Square Distribution
Chronic Disease
Coronary Angiography
Coronary Occlusion / radiography,  therapy*
Female
Humans
Italy
Male
Middle Aged
Risk Assessment
Risk Factors
Stents
Treatment Outcome
Comments/Corrections
Comment In:
Catheter Cardiovasc Interv. 2010 Sep 1;76(3):372-3   [PMID:  20839350 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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