Planned Versus Bailout Rotational Atherectomy: A Systematic Review and Meta-Analysis
Autor: | Saul Lovatt, Josip Anđelo Borovac, Konstantin Schwarz, Chun Shing Kwok, Sathish Parasuraman |
---|---|
Rok vydání: | 2022 |
Předmět: |
Atherectomy
Coronary medicine.medical_specialty Myocardial Infarction Target vessel revascularization Coronary Artery Disease Rotational atherectomy Coronary artery disease Internal medicine medicine Humans Stent thrombosis Vascular Calcification Stroke Retrospective Studies business.industry General Medicine medicine.disease R1 Confidence interval Treatment Outcome Meta-analysis Relative risk Cardiology Stents Cardiology and Cardiovascular Medicine business percutaneous coronary intervention PCI rotational atherectomy planned bailout periprocedural outcomes calcification coronary artery disease rotablation |
Zdroj: | Cardiovasc Revasc Med |
ISSN: | 1553-8389 |
Popis: | 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. |
Databáze: | OpenAIRE |
Externí odkaz: |