Rotablator and radial vs femoral approach

1. Peter Munk Cardiac Centre
University Health Network
Rotation Atherectomy
and
Radial vs. Femoral Approach
Vladimír Džavík MD
Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
AIM-RADIAL, Chicago, October 23, 2014

2. Peter Munk Cardiac Centre
University Health Network
A recanalized RCA?

3. Peter Munk Cardiac Centre
University Health Network
RAO view

4. Peter Munk Cardiac Centre
University Health Network
After wiring

5. Peter Munk Cardiac Centre
University Health Network
Rotawire floppy and a 1.5 mm burr

6. Peter Munk Cardiac Centre
University Health Network
Predilation achieved easily

7. Peter Munk Cardiac Centre
University Health Network
After predilation

8. Peter Munk Cardiac Centre
University Health Network
After stenting – 2 DES

9. from New Jersey
Peter Munk Cardiac Centre
University Health Network

10. Peter Munk Cardiac Centre
University Health Network
Baseline Characteristics
Gioia et al. Catheter and Cardiovasc Intervent 2000;51:234–238

11. Peter Munk Cardiac Centre
University Health Network
Angiographic and Procedural
Characteristics
3 patients discharged same day, 10 next day, 3 on Day 2

12. Peter Munk Cardiac Centre
University Health Network

13. Peter Munk Cardiac Centre
University Health Network
Baseline Characteristics
Watt & Oldroyd Catheter Cardiovasc Intervent 2009;74:550–554

14. Peter Munk Cardiac Centre
University Health Network
Procedural Characteristics
Watt & Oldroyd Catheter Cardiovasc Intervent 2009;74:550–554

15. Peter Munk Cardiac Centre
University Health Network
In-hospital outcomes
Watt & Oldroyd Catheter Cardiovasc Intervent 2009;74:550–554

16. Peter Munk Cardiac Centre
University Health Network

17. Peter Munk Cardiac Centre
University Health Network
Baseline Characteristics
Kassimis et al. EuroIntervention 2014;10:694-699

18. Peter Munk Cardiac Centre
University Health Network
Procedural Characteristics
Kassimis et al. EuroIntervention 2014;10:694-699

19. Peter Munk Cardiac Centre
University Health Network
In-hospital Outcomes
Kassimis et al. EuroIntervention 2014;10:694-699

20. Rotational atherectomy via the radial artery
Peter Munk Cardiac Centre
University Health Network
is associated with similar procedural
success when compared to the
transfemoral route
Mark A. Kotowycz, Sohail Q. Khan, Xavier Freixa, Joan Ivanov, Peter H. Seidelin,
Christopher B. Overgaard, Vladimír Džavík
Interventional Cardiology Program
Peter Munk Cardiac Centre, University Health Network
Toronto, Ontario, Canada
Coronary Artery Disease (in press)

21. Peter Munk Cardiac Centre
University Health Network
Baseline Characteristics
Variable Femoral
n = 67
Radial
n = 52
P value
Age (years) 71.3 ± 10.5 71.0 ± 10.2 0.89
Male 43 (64) 43 (83) 0.03
Smoking (current or
former)
31 (46) 35 (67) 0.02
Hypertension 58 (87) 41 (79) 0.26
Dyslipidemia 58 (87) 44 (85) 0.76
Diabetes 33 (49) 15 (29) 0.02
Prior MI 25 (37) 12 (23) 0.10
Prior PCI 27 (40) 21 (40) 0.86
Prior CABG 11 (16) 9 (17) 0.93
Prior CVA 3 (4) 3 (6) 0.75
Presentation:
Elective 39 (58) 39 (75)
Urgent
(ACS/NSTEMI)
27 (40) 11 (21)
Acute MI (STEMI) 1 (1) 2 (4)
CCS Class 3 or 4 41 (61) 27 (52) 0.31
Kotowycz et al. Coronary Artery Disease (in press)

22. Peter Munk Cardiac Centre
University Health Network
Procedural Characteristics
Variable Femoral
group
n = 67
Radial
group
n = 52
P value
Target Vessel:
Left Main 3 (4) 1 (2) 0.63
LAD 31 (46) 17 (33) 0.13
LCx 6 (9) 11 (21) 0.06
RCA 27 (40) 23 (44) 0.67
ACC/AHA Lesion Type:
A/B1 1 (1) 0 (0)
B2 12 (18) 17 (33)
C 54 (81) 35 (67)
Ad Hoc PCI 7 (10) 6 (12) 0.85
Ad Hoc Rotablation 32 (48) 34 (65) 0.06
Kotowycz et al. Coronary Artery Disease (in press)

23. Peter Munk Cardiac Centre
University Health Network
Procedural Variables
Variable Femoral group
n = 67
Radial group
n = 52
P value
Access site crossover 0 (0) 3 (6) 0.08
Guiding Catheter Size:
6-French 20 (30) 36 (69)
7-French 41 (62) 16 (31)
8-French 6 (9) 0 (0)
Average 6.79 ± 0.59 6.31 ± 0.47 < 0.001
Number of Burrs:
1 39 (58) 26 (50)
2 26 (39) 24 (46)
3 2 (3) 2 (4)
Average Burr Size:
Burr 1 1.34 ± 0.14 1.34 ± 0.13 0.74
Burr 2 1.63 ± 0.16 1.62 ± 0.15 0.82
Burr 3 1.88 ± 0.18 1.75 ± 0 0.42
Kotowycz et al. Coronary Artery Disease (in press)

24. Peter Munk Cardiac Centre
University Health Network
Procedural variables
Variable Femoral group
n = 67
Radial group
n = 52
P value
Successful Rotablation 61 (91) 50 (96) 0.46
Average number of stents 1.66 ± 1.20 1.79 ± 1.54 0.60
Average stent diameter (mm) 2.97 ± 0.48 3.02 ± 0.47 0.60
Stent length (mm) 40.3 ± 27.9 34.2 ± 27.3 0.25
Use of drug-eluting stent (%) 27 (40) 20 (38) 0.71
Use of GP IIb/IIIa Inhibitor (%) 35 (52) 28 (54) 0.86
Insertion of pacing wire (%) 17 (25) 3 (6) 0.0057
Insertion of IABP (%) 6 (9) 1 (2) 0.13
Fluoroscopy time (minutes) 40.5 ± 21.2 43.8 ± 18.1 0.37
Radiation exposure (cGy cm2) 27743 ± 16541 29939 ± 15192 0.50
Contrast used (mL) 429 ± 182 384 ± 189 0.19
Kotowycz et al. Coronary Artery Disease (in press)

25. Peter Munk Cardiac Centre
University Health Network
In-hospital Outcomes
Complication Femoral
n = 67
Radial
n = 52
P value
Death 3 (4.5) 1 (1.9) 0.63
Peri-procedural MI (CK > 2 ULN) 6 (9.0) 3 (5.8) 0.73
Urgent CABG 1 (1.5 ) 0 (0) 1.00
Blood transfusion 3 (4.5) 0 (0) 0.26
MACE (death, MI or urgent CABG) 10 (14.9) 4 (7.7) 0.26
MACE or blood transfusion 11 (16.4) 4 (7.7) 0.18
Kotowycz et al. Coronary Artery Disease (in press)

26. Peter Munk Cardiac Centre
University Health Network
Causes of Death
Patient age/sex Indication Access Burr size (mm) Cause of death
96/F ACS RF 1.25 Tamponade 2º to RA
75/F ACS RF 1.25 Stent thrombosis
76/M ACS LF 1.50 Palliative
88/F STEMI RR 1.50 Bleed

27. Peter Munk Cardiac Centre
University Health Network
A long, dominant LCx lesion

28. Peter Munk Cardiac Centre
University Health Network
Unable to advance a balloon

29. Peter Munk Cardiac Centre
University Health Network

30. Peter Munk Cardiac Centre
University Health Network
IN SUMMARY
• Rotational Atherectomy via the transradial approach is
feasible and associated with results that similar to
those achieved utilizing the transfemoral approach
• Bleeding complications may be decreased