Can Rotawire standalone! Performance of Rotawire as a standalone wire for rotational atherectomy
Keywords:
Calcified lesions, rotational atherectomy, Rotawire standaloneAbstract
Background: With advancements in stent designs and lesion preparation techniques, complex lesions are being increasingly treated using percutaneous approach1. Even with advent of new emerging technologies, the importance of RA cannot be undermined as a first line technique for treating complex calcified lesions1-3.
Objectives: We looked at several aspects including technique, success rate and safety of Rotawireas a standalone wire for Rotational Atherectomy (RA).
Material and Methods: Patients undergoing RA were prospectively assigned to stand alone Rotawire strategy (strategy-A) vs the contemporary technique using workhorse wire and exchanges over a microcatheter (strategy-B). Success rate, wiring fluoro times and complication rate of both strategies were compared.
Results: Twenty-six patients underwent RA from January 2018 to 2020. Strategy-A was selected for 12 and strategy-B for 14 patients, as per operators’ discretion. Baseline and procedural characteristics were similar in both groups. Strategy-A was successful in 11 (91.67%) and strategy-B in 14 (100%) of patients (P=0.29). The wire handling fluoro time was significantly lower for strategy-A vs B(36.83 ± 4.80 vs 96.36 ± 24.51 seconds, P value 0.01), however the total procedural fluoro time was not statistically different (17.75 ± 4.78 vs 19.57 ± 3.58 minutes, P value 0.29). Slow flow was the only complication (A=8.3% vs B=7.1%, P value 0.91), treated successfully with final TIMI-III flow in all patients. The microcatheter usage (8.3% vs 100%, P=0.01) and number of PTCA wires usage (1.08 ± 0.29 vs 2.0± 0,P=0.01), was significantly lower for strategy-A. There was no MACCE at 01 month.
Conclusion: By using proper technique, the Rotawire can be used as a standalone wire for RA assisted interventions. Larger studies can validate it further.
Keywords: Calcified lesions, rotational atherectomy, Rotawire standalone.
References
Gupta T, Weinreich M, Greenberg M, Colombo A, Latib A. Rotational Atherectomy: A Contemporary Appraisal. IntervCardiol 2019;14(3):182–9.
Hayashi T, Tanaka Y, Shishido K et al. Wire bias, insufficient differential sanding, and orbital atherectomy-induced coronary pseudoaneurysm. Circ Cardiovasc Interv 2018;11.
Barbato E, Carrié D, Dardas P et al. European Association of Percutaneous Cardiovascular Interventions. European expert consensus on rotational atherectomy. EuroIntervention 2015; 11:30–36.
Tomey MI, Kini AS, Sharma SK.Current Status of Rotational Atherectomy. JACC Cardiovasc Interv 2014 ;7(4):345-53.
Reisman M, Harms V. Guidewire bias: potential source of complications with rotational atherectomy. Cathet Cardiovasc Diagn 1996;3:64-68.
Oishi Y, Okamoto M, Sueda T et al. Guidewire bias in rotational atherectomy in the angled lesion – evaluation based on the thickness of the ablated intima and media. Circ J 2002;66:659-64.
Yamamoto T, Yada S, Matsuda Y et al. A Novel Rotablator Technique (Low-Speed following High-Speed Rotational Atherectomy) Can Achieve Larger Lumen Gain: Evaluation Using Optimal Frequency Domain Imaging. Hindawi J IntervCardiol 2019.
Lee MS, Wiesner P, Rha SW. Novel Technique of Advancing the Rotational Atherectomy Device: “Single-Operator” Technique. J Inv Cardiol 2016;28(5):183-186.
Kaneko U, Kashima Y, Kanno D, Sugie T, Kobayashi K, Fujita T. Successful rotational atherectomy over RG3 guidewire after failure of various techniques to deliver RotaWire. Cardiovasc IntervTher 2017;32(4):386-91.
Ryan TJ, Faxon DP, Gunnar RM, et al. Guidelines for percutaneous transluminal coronary angioplasty. Circulation 1988;78:486-502.
Ellis SG, Vandormael MG, Cowleyellis MJ et al. Coronary Morphologic and Clinical Determinants of Procedural Outcome With Angioplasty for Multivessel Coronary Disease Implications for Patient Selection. Circulation 1990;82(4):1193-1202.
Mintz GS, Popma JJ, Pichard AD, et al. Patterns of calcification in coronary artery disease. A statistical analysis of intravascular ultrasound and coronary angiography in 1155 lesions. Circulation. 1995;91(7):1959-65.
Alderman E, Stadius M: The angiographic definitions of the Bypass Angioplasty Revascularization Investigation. Current Science 1992;3:1189-1207.
Kahe F, Sharfaei S, Pitliya A. Coronary artery tortuosity: a narrative review. Coronary Artery Disease 2020;31(2):187-192.
Morofuji T, Kuramitsu S, Shinozaki T et al.Clinical impact of calcified nodule in patients with heavily calcified lesions requiring rotational atherectomy. Catheter Cardiovasc Interv 2020;1-10.
Shiraishi J, Nishimura T, Hyogo M, Sawada T. Detection of Trailing Edge of Calcified Nodule After Rotational Atherectomy Using Optical Frequency Domain Imaging. Images in Cardiology. CJC Open 2019;1(4)2016-18.
Mintz GS. Intravascular Imaging of Coronary Calcification and its Clinical Implications. JACC Cardiovasc Imaging 2015;8(4):461-471.
Garcia-Garcia HM, McFadden ,Farb A, Mehran R, Stone GW, Spertus J. Standardized End Point Definitions for Coronary Intervention Trials: The Academic Research Consortium-2 Consensus Document. Circulation 2018;137(24):2635-2650.
Mehta SK, Frutkin AD, Lindsey JB, House JA, Spertus JA, Rao SV. National Cardiovascular Data Registry. Bleeding in patients undergoing percutaneous coronary intervention: the development of a clinical risk algorithm from the National Cardiovascular Data Registry. Circ Cardiovasc Interv 2009;2(3):222-229.
Levine GN, Bates ER, Blankenship JC et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. JACC 2011;58(24):44–122.
