Impact of rotational atherectomy on the incidence of side branch compromise in calcified bifurcation lesions undergoing elective percutaneous coronary intervention

J Cardiol. 2022 Dec;80(6):518-524. doi: 10.1016/j.jjcc.2022.07.004. Epub 2022 Jul 23.


Background: Percutaneous coronary intervention (PCI) to the calcified bifurcation lesion is still a challenging issue even for experienced interventional cardiologists. In such bifurcation lesions, side branch compromise caused by carina-shift or plaque shift just following stent implantation or balloon dilatation is one of the most important complications. It remains unclear whether rotational atherectomy (RA) to the main vessel reduces the incidence of side branch compromise in the calcified bifurcation lesions. The aim of this retrospective study was to compare the incidence of side branch compromise/occlusion between PCI with versus without RA.

Methods: This was a retrospective, single-center study. Side branch compromise/occlusion was defined as final Thrombolysis in Myocardial Infarction flow grade of side branch ≤2/≤1. We included 302 calcified bifurcation lesions, and divided those into the RA group (n = 140) and the non-RA group (n = 162) according to use of RA to the main vessel.

Results: The incidence of side branch compromise/occlusion was significantly less in the RA group than in the non-RA group (compromise: 6.4 % versus 14.2 %, p = 0.038; occlusion: 3.6 % versus 10.5 %, p = 0.017). RA was inversely associated with the incidence of side branch compromise [odds ratio (OR) 0.272, 95 % confidence interval (CI) 0.096-0.772, p = 0.014] and occlusion (OR 0.175, 95 % CI 0.049-0.628, p = 0.008).

Conclusions: RA to the main vessel was associated with a lower incidence of side branch compromise/occlusion. RA to the main vessel only may be a reasonable approach to reduce the risk of side branch compromise/occlusion in calcified bifurcation lesions.

Keywords: Bifurcation lesion; Calcification; Rotational atherectomy.

MeSH terms

  • Atherectomy, Coronary* / adverse effects
  • Coronary Angiography
  • Coronary Artery Disease* / therapy
  • Humans
  • Incidence
  • Percutaneous Coronary Intervention* / adverse effects
  • Retrospective Studies
  • Treatment Outcome