Angiographic Complications Using a Medium or Small Initial Burr-toArtery Ratio for Rotational Atherectomy

Abstract

Objectives: In this prospective cohort study, we investigated the safety and efficacy of rotational atherectomy, comparing the use of an initial small with medium burr-to-artery ratio. Background: Rotational atherectomy (RA) is recommended in heavily calcified lesion preparation. Inadequate RA with a burr-to-artery ratio ≤0.6 is associated with increased rate of instent restenosis A burr-to-artery ratio > 0.7 is associated with an increased risk of immediate post-procedural angiographic complications Thus, selection of the initial burr size for RA remains debatable. Methods: We enrolled 73 patients and 76 RA procedures in three tertiary hospitals, with a 6-month follow-up. The primary endpoint was any serious intraprocedure or immediate post-RA angiographic complications occurring during or after the final RA run, including severe dissection, uncorrectable no-reflow phenomenon, coronary perforation, and burr entrapment (Kokeshi phenomenon). Results: We found no significant difference in the rate of serious complications between treatment groups with burr-to-artery ratio ≤0.6 and >0.6 (6.45% vs. 8.89%, p=1.00). Regarding the reason for considering RA, we found a trend of an increased rate of serious complications with unplanned versus planned RA (11.5% vs. 6.0%, p=0.33) or with inadequate lesion preparation (16.7% vs. 5.2%, p=0.14). Conclusions: For coronary lesions requiring RA, the rate of serious angiographic complications did not differ when using an initial burr size with a burr-to-artery ratio of ≤0.6 or >0.6.