Authors' objectives:

This report aims to systematically review the literature on percutaneous transluminal coronary rotational atherectomy (PTCRA), one of the newer cardiac interventional devices used to treat coronary artery stenoses.

Authors' results and conclusions: When conventional PTCA, with or without stent placement, is feasible (95 per cent of cases), PTCRA appears to confer no additional benefit to the patient. This conclusion is supported by evidence from randomised trials. In cases of in-stent restenosis, there is limited and conflicting published evidence, and no long-term data, to support the routine use of rotational atherectomy. Expert clinical opinion indicates that, in certain circumstances, rotational atherectomy is a useful adjunctive procedure to increase the success of subsequent angioplasty in achieving satisfactory revascularisation in complicated or calcified lesions. In specific cases where conventional angioplasty and stenting cannot be undertaken successfully or is associated with a poor clinical or angiographic outcome, PTCRA appears to be an effective adjunctive procedure to increase the likelihood of successful revascularisation. This conclusion is supported by evidence from case series and clinical experience; however, it may not be possible to undertake randomised trials to verify this.

Authors' recommendations: MSAC recommended that on the evidence pertaining to percutaneous transluminal coronary rotational atherectomy (PTCRA): 1) Public funding is supported for the following specific indications: a) For revascularisation of complex and heavily calcified coronary artery lesions which cannot be treated by percutaneous transluminal coronary angioplasty (PTCA) alone or when previous PTCA attempts have not been successful; and b) For revascularisation of complex and heavily calcified coronary artery stenoses where coronary artery bypass graft (CABG) surgery is contra-indicated. 2) Public funding is not supported for the following indications: a) For revascularisation of coronary artery stenoses which can be satisfactorily treated by PTCA alone, with or without stent placement; and b) For revascularisation of coronary artery in-stent restenoses as a result of prior coronary artery intravascular interventions (since no long-term data exist and short-term data are conflicting).

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.msac.gov.au/

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Medical Services Advisory Committee

Contact Address: MSAC (MDP 107), GPO Box 9848, Canberra, ACT 2601, Australia. Tel: +61 2 6289 6811; Fax: +61 2 6289 8799.

Contact Name: msac.secretariat@health.gov.au

Contact Email: msac.secretariat@health.gov.au

Copyright: Medical Services Advisory Committee (MSAC)