ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Atherosclerosis and Vascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1650595
Rotational vs. Laser Atherectomy in Chinese CTO-PCI: Lesion-Specific Efficacy with Comparable Midterm Safety
Provisionally accepted
Liansheng Chen1
Zehan Huang2
Quanmin Wu2Huiliang Deng2Meiping Huang2Yiqi Xu3Jinkun Wei4Yong Liu2Nianjin Xie2
Yuming Huang2*- 1Other
- 2Guangdong Provincial People's Hospital, Guangzhou, China
- 3Southern Medical University, Guangzhou, China
- 4Xiaolan People's Hospital of Zhongshan, Zhongshan, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) often requires plaque modification for device delivery. While rotational atherectomy (RA) and excimer laser coronary atherectomy (ELCA) are established adjuncts, their comparative efficacy and safety remain underexplored in Chinese populations. Methods: This single-center retrospective study included 75 consecutive CTO-PCI patients treated with ELCA (n=25) or RA (n=50). Procedural success, complications, and major adverse cardiovascular and cerebrovascular events (MACCE) were analyzed over a median 17.5-month follow-up. Multivariable Cox regression adjusted for calcification severity, lesion length, ISR-CTO, and diabetes mellitus. Results: RA was preferred for moderate/severe calcification (76% vs. 48%, p = 0.020), while ELCA dominated in ISR-CTO (20% vs. 2%, p = 0.024) and lesions >20 mm (56% vs. 30%, p = 0.044). Procedural success was comparable (RA 90% vs. ELCA 84%, p = 0.706). Procedure-related complications differed: RA had two coronary perforations (4% vs. 0%, p = 0.130), whereas ELCA showed a trend toward more transient slow/no-reflow (12% vs. 0%, p = 0.061). MACCE rates remained similar (19% vs. 13.3%, p = 0.815; adjusted HR 1.53, 95% CI 0.35–6.65, p = 0.569). Both techniques exhibited comparable procedural duration and radiation exposure (all p > 0.05). ELCA incurred higher total costs (US11,147 vs. 9,267, p = 0.007), driven by laser catheter expenses; however, procedural costs became comparable after excluding catheter-related expenditures (p = 0.210). 2 Conclusion: In Chinese CTO-PCI, ELCA and RA demonstrate lesion-specific utility—ELCA for ISR-CTO and long lesions, RA for calcified lesions—with comparable midterm safety. Procedural costs of ELCA and RA were equivalent in Device-excluded costs analysis.
Keywords: chronic total occlusion, Percutaneous Coronary Intervention, in-hospital outcomes, Long-term outcomes, Excimer laser coronary atherectomy, Rotational atherectomy, Procedural costs
Received: 20 Jun 2025; Accepted: 13 Oct 2025.
Copyright: © 2025 Chen, Huang, Wu, Deng, Huang, Xu, Wei, Liu, Xie and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yuming Huang, phuangyuming@163.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.