Coronary angioplasty and Rotablator atherectomy trial (CARAT): Immediate and late results of a prospective multicenter randomized trial

Mechanical rotational atherectomy with the Rotablator is widely used for pe rcutaneous coronary revascularization, but the ideal debulking strategy rem ains unknown. The purpose of this study was to compare the immediate and la te results after Rotablator using two treatment strategies: Large burrs (bu rr/artery ratio of >0.7) to achieve maximal debulking (lesion debulking str ategy) or small burrs (burr/artery ratio less than or equal to 0.7) to modi fy lesion compliance (lesion modification strategy). Two hundred twenty-two patients at six centers were prospectively enrolled in this study and rand omly assigned to large (n = 104 patients with 118 lesions) or small (n = 11 8 patients with 136 lesions) burrs, The primary endpoint was final diameter stenosis at the end of the procedure, and secondary endpoints included inh ospital angiographic and clinical complications, and target lesion revascul arization at 6 months. Baseline demographic and angiographic characteristic s were similar. There were no differences in procedural success, the extent of immediate lumen enlargement, inhospital ischemic complications, or late target Vessel revascularization. However, compared with small burrs, patie nts randomized to large burrs were more likely to experience serious angiog raphic complications (5.1% vs. 12.7%, P < 0.05) immediately after atherecto my. This study suggests that a routine lesion modification strategy employi ng small burrs (burr/artery ratio I 0.7) achieves similar immediate lumen e nlargement and late target Vessel revascularization compared with a more ag gressive debulking strategy (burr/artery ratio >0.7), but with fewer angiog raphic complications, (C) 2001 Wiley-Liss, Inc.