Feasibility and safety of minimal-contrast IVUS-guided rotational atherectomy for complex calcified coronary artery disease



To assess the feasibility and safety of minimal-contrast percutaneous coronary intervention (PCI) using rotational atherectomy (RA) in patients with severe coronary calcification at high-risk of contrast-associated acute kidney injury (AKI).


Twenty-six patients with advanced chronic kidney disease undergoing PCI with RA at three high-volume centres were included. Baseline intravascular ultrasound (IVUS) was performed to assess lesion morphology, and to guide burr-, balloon-, and stent-selection. Final result was assessed by IVUS and angiographically. Feasibility and safety were determined by procedural and in-hospital complications, and efficacy was assessed by freedom from contrast-associated AKI after PCI. Procedural and in-hospital outcome was compared to a propensity-matched population of standard RA PCI.


Mean glomerular filtration rate was 32 ± 17 ml/min/1.73 m2. In seven cases PCI was performed in the setting of acute coronary syndrome. The left main coronary artery was treated in 27.8% and a two-stent bifurcation technique in 44.4%. RA was more often performed electively compared to the standard RA cohort (92.3 vs. 50%; p = 0.0016). Angiographic success was achieved in 100% and documented with a median contrast amount of 12.5 ml [Range 4–43]. No in-hospital death or myocardial infarction was reported. Contrast-associated AKI occurred in one patient versus five patients in standard RA group (p = 0.19). Shorter fluoroscopy time and lower radiation dose were achieved as compared to standard RA.


A minimal-contrast RA approach with IVUS-guidance for treatment of complex calcified coronary lesions is feasible and safe with high success rate.

Graphic abstract

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Fig. 1
Fig. 2

Availability of data and material

Data analysis was performed in the Heart Centre Segeberger Kliniken GmbH and data are available.



Acute kidney injury


Chronic coronary syndrome


Intravascular ultrasound


Non-ST-elevation acute coronary syndrome


Percutaneous coronary intervention


Rotational atherectomy


Renal replacement therapy


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Correspondence to Abdelhakim Allali.

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Conflict of interest

Dr. Allali is a consultant for Boston Scientific. Dr. Abdel-Wahab declares that his hospital receives speaker’s honoraria and/or consulting fees on his behalf from Boston Scientific and Medtronic. Dr. Hemetsberger is an honorary speaker for Boston Scientific. Dr. Richardt has received institutional research grants from St. Jude Medical, Biotronik and Medtronic. Dr. Woitek is a consultant for Boston Scientific. Dr. Norman reports personal fees from Edwards Lifesciences, Medtronic, Biotronik, Novartis, Sanofi Genzyme, AstraZeneca, Pfizer, and Bayer, outside the submitted work. The other authors have no conflicts of interest to declare.

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Allali, A., Traboulsi, H., Sulimov, D.S. et al. Feasibility and safety of minimal-contrast IVUS-guided rotational atherectomy for complex calcified coronary artery disease. Clin Res Cardiol (2021). https://doi.org/10.1007/s00392-021-01906-y

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  • Rotational atherectomy
  • Chronic kidney disease
  • Contrast-associated acute kidney injury
  • Intravascular ultrasound