Planned Versus Bailout Rotational Atherectomy: A Systematic Review and Meta-Analysis

Konstantin Schwarz, Saul Lovatt, Josip A Borovac, Sathish Parasuraman, Chun Shing Kwok

Research output: Journal article (peer-reviewed)Journal article

2 Citations (Scopus)

Abstract

BACKGROUND/PURPOSE: Rotational atherectomy (RA) plays a central role in the treatment of heavily calcified coronary artery lesions. Our aim was to compare periprocedural characteristics and outcomes of planned (PA) vs. bailout (BA) rotational atherectomy.

METHODS: We conducted a systematic review and performed a meta-analysis on studies which compared PA vs. BA strategy.

RESULTS: Five studies fulfilled the inclusion criteria, pooling a total of 2120 patients. There was no difference in procedural success, PA vs. BA risk ratio (RR) 1.03 and 95% confidence interval (95% CI) 0.99-1.07. Compared to BA, PA was associated with a shorter procedural time [mean difference (MD) -25.88 min, 95% CI -35.55 to -16.22], less contrast volume (MD -43.71 ml, 95% CI -69.17 to -18.25), less coronary dissections (RR 0.50, 95% CI 0.26-0.99), fewer stents (MD -0.20, 95% CI -0.29 to -0.11), and a trend favouring less periprocedural myocardial infarctions (MI) (RR 0.77, 95% CI 0.54-1.11). There was no difference in major adverse cardiovascular events on follow-up (RR 1.04, 95% CI 0.62-1.74), death (RR 0.98, 95% CI 0.59-1.64), MI (RR 1.16, 95% CI 0.62-2.18), target vessel revascularization (RR 1.40, 95% CI 0.83 to 2.36), stroke (RR 1.50, 95% CI 0.46-4.86) or stent thrombosis (RR 0.82, 95% CI 0.06-10.74); all PA vs. BA comparisons.

CONCLUSIONS: Compared to bailout RA, planned RA resulted in significantly shorter procedural times, less contrast use, lesser dissection rates and fewer stents used. The bailout RA approach appears to enhance periprocedural risk, but there is no difference on mid-term outcomes.

Original languageEnglish
Pages (from-to)45-51
Number of pages7
JournalCardiovascular revascularization medicine : including molecular interventions
Volume39
DOIs
Publication statusPublished - Jun 2022

Keywords

  • Atherectomy, Coronary/adverse effects
  • Coronary Artery Disease/diagnostic imaging
  • Humans
  • Myocardial Infarction/etiology
  • Retrospective Studies
  • Stents
  • Treatment Outcome
  • Vascular Calcification/diagnostic imaging

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