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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Clinical Trails Review of,Rotational Atherectomy,Clinical Trails Review ofRota,1,Contents,Mechanisms,of Rotational Atherectomy,Safety and Efficacy of Rotational Atherectomy,Technical Parameters of Rotational Atherectomy,Management of Rotational Atherectomy Complications,ContentsMechanisms of Rotation,Contents,Mechanisms,of Rotational Atherectomy,Safety and Efficacy of Rotational Atherectomy,Technical Parameters of Rotational Atherectomy,Management of Rotational Atherectomy Complications,ContentsMechanisms of Rotation,Rotablator,mechanisms,Cavusoglu,et al,.,J Vasc Surg 1988;7:292300.,High-speed mechanical RA relies on,plaque ablation and pulverization by,the abrasive diamond-coated burr.,The Rotablator is able to ablate inelastic tissue selectively while maintaining the integrity of elastic due to the principle of differential cutting.,The abraded plaque is pulverized into microparticles,which are 5-10m in diameter.These particles are small enough to passthrough the coronary microcirculation and ultimately undergo phagocytosis in the liver,spleen,and lung.,RotablatormechanismsCavusogl,4,Roblator,compared,with,common,balloon angioplasty,Effect,of,Balloon Dilatation,and,ROTA,on,vascular wall,A,B,C,Ahn,et al,.,J Vasc Surg 1988;7:292300.,Roblatorcompared with commo,5,Mechanisms,of Rotational Atherectomy,Safety and Efficacy of Rotational Atherectomy,Technical Parameters of Rotational Atherectomy,Management of Rotational Atherectomy Complications,Contents,Mechanisms of Rotational Ather,Roblator,outcome,Abdel-Wahab,et al,.Catheter Cardiovas Interv 2013;81:285291.,In-hospital events(n=205),Long-term events(n=188),Death,n(%),3(1.5),17(9.0),Cardiac,n(%),7(3.7),Noncardiac,n(%),4(2.1),Unknow,n(%),6(3.2),MI,n(%),5(2.4),5(2.7),Q-wave,n(%),2(1.1),Non-Q-wave,n(%),3(1.6),TLR,n(%),0,15(7.9),TVR,n(%),1(0.5),21(11.2),MACE,*,n(%),9(4.4),39(20.7),In-Hospital and Long-Term Outcome,#,#,Median,Follow-Up=15 Months,Range,=,184 Months.,*,Defined as death,MI and TVR.,RoblatoroutcomeAbdel-Wahab e,7,Rainer,et al,.,Am J Cardiol 1998;81:552557,.,QCA,of,ROTA,Stent and ROTA+Stent,ROTA,(n=147),Stent,(n=103),ROTA+Stent,(n=56),p,Value,Reference diameter(mm),3.20 0.34,3.36 0.52,3.35 0.48,0.0001,MLD,Pretreatment(mm),1.01,0.46,1.06,0.57,1.12,0.45,0.4382,Final(mm),2.29,0.55,2.88,0.51,3.21,0.49,0.0001,Diameter stenosis,Pretreatment(%),68,15,68,16,66,15,0.7584,Final(%),27,17,14,13,4,15,0.0001,Acute diameter gain(mm),1.28,0.61,1.81,0.66,2.17,0.60,0.0001,Roblatoroutcome,Rainer et al.Am J Cardiol 199,8,Rainer,et al,.,Am J Cardiol 1998;81:552557,.,Event-free survival-curves for each of the 3 treatment,modalities during 9-month follow-up,Roblatoroutcome,Rainer et al.Am J Cardiol 199,9,A strategy of ROTA and DES implantation is a safe and effective treatment option in complex patients with complex calcified lesions.,Long-term revascularisation rates do not differ from the experience with DES in less severe patient and lesion subsets.,ROTA and DES appear to be particularly effective in elderly patients.,Abdel-Wahab,et al,.Catheter Cardiovas Interv 2013;81:285291.,Roblatoroutcome,A strategy of ROTA and DES imp,10,Dill,et al,.Eur Heart J 2000;21:17591766.,The COBRA Study,A randomized comparison of balloon angioplasty versus rotational atherectomy in complex coronary lesions(COBRA study),T.Dill,U.Dietz,C.W.Hamm,R.Kchler,H.-J.Rupprecht,M.Haude,J.Cyran,C.zbek,K.-H.Kuck,J.Berger and R.Erbel,Dill et al.Eur Heart J 2000;2,11,Dill,et al,.Eur Heart J 2000;21:17591766.,KaplanMeier survival curves for,patients,undergoing,Angioplasty,Rotablator,The,COBRA Study,Dill et al.Eur Heart J 2000;2,12,Dill,et al,.Eur Heart J 2000;21:17591766.,Risk differences and 95%CI for,event-free procedural outcome,The,COBRA Study,Dill et al.Eur Heart J 2000;2,13,Dill,et al,.Eur Heart J 2000;21:17591766.,Complex coronary artery lesions can be treated with a high level of success and low complication rates either by PTCA with adjunctive stenting or rotablation.The long-term clinical and angiographic outcome is comparable.,The,COBRA Study,Dill et al.Eur Heart J 2000;2,14,The ROTAXUS trial(9-month),Abdel-Wahab,et al,.J Am Coll Cardiol Intv 2013;6:10,19,.,High-Speed Rotational Atherectomy Before Paclitaxel-Eluting Stent Implantation in Complex Calcified Coronary Lesions,The Randomized ROTAXUS(Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease)Trial,Mohamed Abdel-Wahab,Gert Richardt,Heinz Joachim Buttner,Ralph Toelg,Volker Geist,Thomas Meinertz,Joachim Schofer,Lamin King,Franz-Josef Neumann,Ahmed A.Khattab,The ROTAXUS trial(9-month)A,15,Abdel-Wahab,et al,.J Am Coll Cardiol Intv 2013;6:,10-19,.,240 patients enrolled between August 2006 and March 2010 at 3 clinical sites in Germany,240 patients analyzed with complete in-hospital follow-up,Angiographic follow-up at 9 months in 80.5%(N=190),Clinical follow-up at 9 months in 96.2%(N=227),1:1 randomization,PTCA+PES,(N=120),Rota+PES,(N=120),2 patients died in-hospital
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