Safety and Efficacy of Rotational Atherectomy (RA) in Coronary Dissection

Coronary artery dissection is a contraindication for the use of rotational atherectomy, since rotational atherectomy may propagate coronary dissection. In the presence of coronary dissection, conservative management is suggested for approximately 4 weeks to permit the dissection to heal prior to treatment with rotational atherectomy. However, a lot of patients have frequent angina attacks and some patients develop serious complications including abrupt vessel closure during this period. Thus, immediate strategies cope with coronary dissection induced by balloon dilation is needed for the early recovery of those patients. The present study was performed to compare the safety and efficacy of immediate RA and delayed RA in the treatment with nondilatable calcified lesion complicated by coronary dissection.

Inclusion criteria

• age between 30 and 85 years old
• nondilatable calcified lesion complicated by coronary dissection during percutaneous coronary intervention (PCI) procedure
• Coronary artery dissection type A, B and type C according to the National Heart, Lung and Blood Institute (NHLBI) coronary dissection criteria

Exclusion criteria

• acute myocardial infarction
• unprotected left main stenosis
• chronic total occlusion
• saphenous vein graft lesion
• cardiomyopathy
• severe valvular heart disease
• NYHA functional class IV heart failure at baseline
• chronic renal failure on hemodialysis
• severe lung and liver disease or cancer