Khalefa Basma Badrawy, Ayyad Mohammed, Alqeeq Basel F, Albandak Maram, Ayyad Alaa, Awad Ahmed K, Gonnah Ahmed R, Roberts David H
Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Catheter Cardiovasc Interv. 2025 Mar;105(4):909-926. doi: 10.1002/ccd.31380. Epub 2025 Jan 9.
Coronary calcification is a major factor leading to stent under-expansion, and subsequent adverse events. This meta-analysis aimed to evaluate the short and long‑term outcomes of rotational atherectomy (RA), followed by modified balloon (cutting or scoring) (MB) versus plain balloon before drug‑eluting stent implantation for calcified coronary lesions. We searched PubMed, Web of Science (WOS), Scopus, and the Cochrane Library Central Register of Controlled Trials (CENTRAL), from inception until 30 January 2024. The risk ratio (RR) with a 95% confidence interval (CI) was used to compare dichotomous outcomes, while continuous outcomes were reported in form of mean difference (MD). Our study included seven studies with 309 patients undergoing RA followed by MB angioplasty, and 414 patients had RA followed by conventional plain balloon angioplasty, before stent implantation. Our analysis revealed no significant difference in-hospital mortality (RR = 0.64, 95% CI [0.18, 2.23], p = 0.49), or long-term mortality (RR = 0.65, 95% CI [0.18, 2.36], p = 0.51). MACE were significantly lower in the cutting balloon group (RR = 0.58, 95% CI [0.37, 0.92], p = 0.02). Angiographic minimum lumen diameter, and change in percent diameter stenosis were significantly higher in the MB group (MD = 0.19, 95% CI [0.08, 0.31], p = < 0.01), and (MD = 3.75, 95% CI [0.76, 6.74], p = 0.01) respectively. No difference was found regarding target lesion revascularization (RR: 0.50, 95% CI [0.24, 1.04], p = 0.06), or target vessel revascularization (RR: 0.71, 95% CI [0.38, 1.33], p = 0.28). RA followed by MB is as safe plain balloon angioplasty before stent implantation in moderate to severely calcified coronary lesions. Moreover, it is associated with significantly better immediate angiographic outcomes, and significantly lower MACE.
冠状动脉钙化是导致支架扩张不全及随后不良事件的主要因素。本荟萃分析旨在评估在药物洗脱支架植入前，对于钙化冠状动脉病变，采用旋磨术（RA）联合改良球囊（切割或刻痕）（MB）与普通球囊相比的短期和长期结果。我们检索了PubMed、科学网（WOS）、Scopus以及Cochrane图书馆对照试验中央注册库（CENTRAL），检索时间从建库至2024年1月30日。采用风险比（RR）及95%置信区间（CI）比较二分变量结果，连续变量结果以平均差（MD）形式报告。我们的研究纳入了7项研究，其中309例患者在支架植入前接受了RA联合MB血管成形术，414例患者接受了RA联合传统普通球囊血管成形术。我们的分析显示，两组在院内死亡率（RR = 0.64，95% CI [0.18, 2.23]，p = 0.49）或长期死亡率（RR = 0.65，95% CI [0.18, 2.36]，p = 0.51）方面无显著差异。切割球囊组的主要不良心血管事件（MACE）显著更低（RR = 0.58，95% CI [0.37, 0.92]，p = 0.02）。MB组的血管造影最小管腔直径及直径狭窄百分比变化显著更高，分别为（MD = 0.19，95% CI [0.08, 0.31]，p < 0.01）和（MD = 3.75，95% CI [0.76, 6.74]，p = 0.01）。在靶病变血运重建（RR：0.50，95% CI [0.24, 1.04]，p = 0.06）或靶血管血运重建方面（RR：0.71，95% CI [0.38, 1.33]，p = 0.28）未发现差异。对于中重度钙化冠状动脉病变，在支架植入前，RA联合MB与普通球囊血管成形术一样安全。此外，它与显著更好的即刻血管造影结果及显著更低的MACE相关。
