ROTACUT Study: Rotational Atherectomy with Cutting Balloon for Stent Expansion Optimization

Approximately 30% of patients undergoing percutaneous coronary intervention (PCI) present moderate to severe calcified lesions, which presents a significant challenge involving a high incidence of major adverse cardiovascular events (MACE). Rotational atherectomy (RA) is used to modify these calcified lesions and facilitate balloon angioplasty followed by stent implantation. The combination of RA with other plaque prepping devices might improve outcomes in the long run. 

Estudio ROTACUT: Aterectomía rotacional con ¨cutting balón¨para optimizar expansión del stent

The aim of this prospective randomized study was to look into whether the combination of RA with cutting balloon (RA + CBA) results in better stent expansion vs. RA followed by non-compliant balloon (RA + NCBA).

Primary end point was minimum stent area after intervention, assessed by IVUS. Secondary end point included segment minimal lumen area, stent expansion, any dissection and malapposition. Researchers looked at 30-day clinical outcomes, including all-cause mortality, acute myocardial infarction, target vessel revascularization, instent thrombosis, major bleeding and vascular complications.

60 patients were randomized: 29 were treated with RA + CBA and 31 with RA + NCBA. Mean age was 71, and they were mostly men. Baselines characteristics in both groups were similar, with close to 60% of patients presenting single vessel disease and close to 20% presenting triple vessel disease. The most treated artery was the anterior descending in most patients, followed by the right coronary.

Read also: Drug-Coated Balloons (DCB): Sirolimus vs. Paclitaxel in De Novo Lesions in Small Vessels.

As regards primary end point, minimum stent lumen area was similar in both groups, with 6.7 ± 1.7 mm2 for RA + CBA patients and 6.9 ± 1.8 mm2 for RA + NCBA patients (p=0.685). Also, there were no differences in secondary end point. As regards clinical complications, there were two AMIs and one target vessel revascularization among RA + CBA patients and one AMI in the RA + NCBA group.

Conclusion 

In conclusion, the combination of RA with cutting balloon resulted in similar minimum stent area vs. RA followed by non-compliant balloons in patients with coronary lesions with moderate to severe calcification. RA followed by cutting balloon resulted safe, with few post procedural complications, and few adverse clinical events at 30 days. 

Dr. Andrés Rodríguez

Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.

Original Title: Rotational atherectomy with cutting balloon to optimize stent expansion in calcified lesions: The ROTACUT randomized trial

Reference: Samin K Sharma, MD et al EuroIntervention 2023;19:1-1.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....