Changes in incidence of rotablation-induced coronary perforation by modifying practice over time: experiences at a high-volume center.

Background: Rotational atherectomy (RA)-induced coronary perforation (CP) represents a dreaded complication, with incidence rates remaining constant and non-negligible for patient safety. Objective: In 2020, we published a paper on four mechanisms of RA-induced CP. In this paper, we hypothesized that modifying practice through general awareness of the mechanisms of RA-induced CP and providing mentorship could lead to a reduction in the incidence of CP. Methods: Consecutive RA patients were recruited and stratified into two groups: January 2009 to December 2019 (Period I) and January 2020 to February 2024 (Period II). During Period II, efforts (structured education, case advice, and case review) to promote general awareness of the four mechanisms of the RA-induced CP were made and mentorship from experienced operators was provided to ensure adherence to good RA practice. Results: A total of 877 patients were recruited: 510 in Period I and 367 in Period II. Most RA procedures were performed for single vessels in both periods. For non-left main vessels, more distally located and bifurcation lesions were treated in Period I, but the incidence of severe calcification was slightly higher in Period II than in Period 1. Less RA was performed for side branches only, and the use of only the 1.25 mm burr increased in Period II. RA could be successfully completed in a high percentage of patients in both periods (98.4% vs. 98.4%, Conclusion: Modifying RA practice through general awareness of the four mechanisms of RA-induced CP and provision of mentorship from experienced operators helped lower the incidence of this fearful complication.