Safety and feasibility of rotational atherectomy in chronic total occlusion: a systematic review and meta-analysis.

BACKGROUND

There is a lack of data available on the feasibility of rotational atherectomy (RA) in chronic total occlusion (CTO) lesions compared to RA in non-CTO lesions. So, we aimed to study the safety and feasibility of RA in patients with CTO lesions compared to non-CTO lesions.

METHODS

We searched PubMed, Scopus, Web of Science (WOS), and Ovid until March 2024. We included all relevant studies assessing RA in CTO lesions versus non-CTO lesions. The primary outcome of interest was major adverse cardiovascular events (MACE), while secondary outcomes were all-cause death, cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR). Other studied angiographic outcomes were vessel perforation, technical success, and procedural success. The pooled data was analyzed using odds ratio (OR) with its 95% CI in using a random-effect model.

RESULTS

Four studies comprising 1925 patients were included in the analysis. The pooled analysis showed that RA in CTO lesions was associated with higher rates of vessel perforation (OR = 3.56, 95% CI: 1.59-7.98, p < 0.001) compared to the non-CTO lesions. On the other hand, no significant differences were observed regarding studied clinical outcomes and angiographic outcomes between CTO and non-CTO lesions.

CONCLUSION

RA for CTO lesions was associated with comparable clinical and angiographic outcomes. RA is a safe and feasible approach in CTO lesions, despite a higher incidence of vessel perforation. More investigations on the severity of each case should be guided in further studies.