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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021
AFRICA
31
chronic kidney disease, as well as patients with ostial lesions also
recommend that one should consider this hybrid strategy.
9,24,25
The study by Rissanen
et al
. enrolled 65 patients, who
were followed for a period of 17 months; 82% of patients
had at least one risk factor for bleeding. Risk factors in this
study included anticoagulation (40%), anaemia (45%), active
malignancy (1.5%), prior stroke (22%), severe renal dysfunction
with an eGFR
<
30 ml/kg/min (3%), age
>
80 years (31%) and
prior bleeding requiring intervention (25%). MACE occurred
in 20% of patients at 24 months. The incidence of significant
bleeding was 9% at 12 months.
This study, which was published in 2017, was the first to show
that PCI using DEB after rotablation was safe and effective.
Compared to our study, we had a similar elderly population with
34.8% aged
>
80 years, fewer patients on anticoagulation (26.1%)
and more with severe renal dysfunction (13%). More studies
are needed to show the prevalence of rotablation and different
novel ways to approach revascularisation in these patients with
calcification and high risk of bleeding.
There were limitations to this study. This was a retrospective
audit of files, which would limit one’s acquisition of data and
follow up. Patients were not routinely followed up with repeat
coronary angiography, which could have affected the incidence
of restenosis and new TLR.
Conclusion
The hybrid approach of rotablation and DEB is a novel approach
in patients with coronary calcification and a bleeding risk. These
patients are more commonly elderly male patients with renal
failure. Bleeding risk can be reduced in these high-risk patients
as DAPT could be stopped by three months in a significant
proportion (
>
25%) of patients. This study has also shown that
bleeding rates in this high-risk cohort over a 24-month period was
extremely low and that restenosis rates were acceptable. In our
cohort, we have confirmed prior observations that the procedure
of DEB following lesion preparation with rotational atherectomy
is safe and effective for patients with a high risk of bleeding.
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