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Review
. 2024 Jan 2;24(1):4.
doi: 10.1186/s12872-023-03673-2.

Safety and feasibility of rotational atherectomy (RA) versus conventional stenting in patients with chronic total occlusion (CTO) lesions: a systematic review and meta-analysis

Ahmed Abdelaziz  1   2 , Hanaa Elsayed  3   4 , Aboalmagd Hamdaalah  5 , Karim Atta  1   6 , Ahmed Mechi  7 , Hallas Kadhim  8 , Aya Moustafa Aboutaleb  1   9 , Ahmed Elaraby  1   2 , Mohamed Hatem Ellabban  1   2 , Fayed Mohamed Rzk  1   10 , Mahmoud Eid  1   5 , Hadeer Elsaeed AboElfarh  1   11 , Rahma AbdElfattah Ibrahim  1   12 , Emad Addin Zawaneh  1   13 , Mahmoud Ezzat  1   10 , Mohamed Abdelaziz  1   2 , Abdelrahman H Hafez  1   2 , Shaimaa Fadel  1   14 , Hazem S Ghaith  1   2 , Mustafa Suppah  15
Affiliations
Review

Safety and feasibility of rotational atherectomy (RA) versus conventional stenting in patients with chronic total occlusion (CTO) lesions: a systematic review and meta-analysis

Ahmed Abdelaziz et al. BMC Cardiovasc Disord. .

Abstract

Background and aim: Interventional cardiologists face challenges in managing chronic total occlusion (CTO) lesions, with conflicting results when comparing rotational atherectomy (RA) to conventional PCI. This meta-analysis aims to provide a critical evaluation of the safety and feasibility of RA in CTO lesions.

Methods: PubMed, Scopus, Web of Science, Ovid, and Cochrane central library until April 2023 were searched for relevant studies. MACE was our primary outcomes, other outcomes were all cause of death, cardiac death, MI, and TVR. Also, we reported angiographic outcomes as technical success, procedural success, and procedural complications in a random effect model. The pooled data was analyzed using odds ratio (OR) with its 95% CI using STATA 17 MP.

Results: Seven studies comprising 5494 patients with a mean follow-up of 43.1 months were included in this meta-analysis. Our pooled analysis showed that RA was comparable to PCI to decrease the incidence of MACE (OR = 0.98, 95% CI [0.74 to 1.3], p = 0.9). Moreover, there was no significant difference between RA and conventional PCI in terms of other clinical or angiographic outcomes.

Conclusion: Our study showed that RA had comparable clinical and angiographic outcomes as conventional PCI in CTO lesions, which offer interventional cardiologists an expanded perspective when addressing calcified lesions.

Prospero registration: CRD42023417362.

Keywords: CTO lesions; Non-CTO lesions; PCI; RA.

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Conflict of interest statement

There was no conflict of interest among all authors.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Risk of bias assessment tool-2 (ROB-2) for RCTs
Fig. 3
Fig. 3
Forest plot of MACE. RA: rotational atherectomy, PCI: percutaneous coronary intervention, CI: confidence interval
Fig. 4
Fig. 4
Galbraith plot assessing heterogeneity across studies assessed MACE
Fig. 5
Fig. 5
DOI plot assessing publication bias of MACE. LFK= -3.09, indicating major asymmetry
Fig. 6
Fig. 6
Forest plot of all-cause death. CI: Confidence interval, RA: rotational atherectomy, PCI: percutaneous coronary intervention
Fig. 7
Fig. 7
Forest plot of cardiac death. CI: Confidence interval, RA: rotational atherectomy, PCI: percutaneous coronary intervention
Fig. 8
Fig. 8
Forest plot of TVR. CI: Confidence interval, RA: rotational atherectomy, PCI: percutaneous coronary intervention
Fig. 9
Fig. 9
Forest plot of MI. CI: Confidence interval, RA: rotational atherectomy, PCI: percutaneous coronary intervention
See this image and copyright information in PMC

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