Novel approach to rotational atherectomy results in low restenosis rates in long, calcified lesions: Long-term results of the San Antonio Rotablator Study (SARS)

Ablation technique and adjunctive strategy may affect restenosis after rotational atherectomy. To minimize trauma to the vascular wall, we changed the technique of rotablation as follows: the RPM range was decreased to 140,000-160,000 RPM, the ablation was performed using a repetitive pecking motion, avoiding a decrease in the rotational speed of the burr greater than 3,000 RPM, long lesions were divided into segments and each segment was separately ablated, and the burr-to-artery ratio was intended to be approximately 0.75. To prevent coronary spasm, before and after each pass, 100-200 μg nitroglycerin and 100-200 μg verapamil i.c. boluses were administered. Adjunctive PTCA was performed using a closely sized 1.1:1 balloon-to-artery ratio with a noncompliant balloon at low pressures for 120 sec. The study incorporated 111 patients with a combined total of 146 calcified lesions. Results. A total of 31.5% of patients underwent a multivessel procedure. No deaths occurred. Q-wave MI and/or creatine kinase elevation greater than three times baseline levels occurred in 4.5% of patients. By quantitative coronary angiography (QCA), the reference vessel diameter was 3.13±0.59 mm, mean lesion length was 33.41±18.58 mm. Percent stenosis and mean luminal diameter were as follows: at baseline 75.7%±10.8%, or 0.76±0.41mm, Post-rotational atherectomy 41.5%±3.6%, or 1.83±0.43 mm, Post-PTCA 18.2%±11.9%, or 2.56±0.50 mm. Six-month angiographic follow-up was available in 64 (57.7%) pts. Net luminal gain was 1.15±0.76 mm, with a late luminal loss of 0.65±0.84 mm. The mean diameter stenosis at follow-up was 37.6%±28.5%, with MLD 1.91±1.21 mm. The binary restenosis rate was 28.1%. Therefore, modification of rotational atherectomy technique with adjunctive PTCA resulted in a favorable restenosis rate in long, calcified lesions.