Safety and Efficacy of Different Rotational Speed during Rotational Atherectomy in Coronary Heart Disease Patients (RACE): study protocol for a randomized controlled trial

Safety and Efficacy of Different Rotational Speed during Rotational Atherectomy in Coronary Heart Disease Patients (RACE): study protocol for a randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Safety and Efficacy of Different Rotational Speed during Rotational Atherectomy in Coronary Heart Disease Patients (RACE): study protocol for a randomized controlled trial Jie Xu, Yuwei Wang, Jiawei Wu, Li-Kun Ma, Hao Hu, Hong-Wu Chen, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5129794/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Apr, 2025 Read the published version in Trials → Version 1 posted 5 You are reading this latest preprint version Abstract Introduction The increasing incidence of coronary heart disease, driven by socio-economic development and population aging, poses significant challenges. Coronary calcification, a major factor complicating percutaneous coronary interventions (PCI), often necessitates rotational atherectomy (RA) for lesion preparation. However, the impact of different RA rotational speeds on procedural and clinical outcomes remains unclear. While low-speed RA (LSRA) has been suggested to reduce intraoperative slow flow, evidence is inconsistent, and the benefits of combining LSRA with high-speed RA (HSRA) are not well established. This study aims to evaluate the effectiveness of different rotational speed protocols to guide clinical practice. Methods and analysis This single-center, randomized controlled trial will target patients with severe coronary artery calcification scheduled for RA. An estimated 210 patients will be enrolled based on sample size calculation, randomly assigned in a 1:1:1 ratio to different rotational speed protocols using a random number table. These will include a continuous low-speed rotation (LSRA) group (140,000 rpm), a continuous high-speed rotation (HSRA) group (180,000 rpm), and a high-speed to low-speed rotation (HSRA + LSRA) group (initially 180,000 rpm, followed by 100,000 rpm). The primary endpoint is the incidence of complications during RA, including coronary artery spasm, slow/no reflow, dissection, burr entrapment, guidewire fracture, and perforation. Secondary outcomes encompass intravascular imaging (IVUS or OCT) assessments (detecting calcific ring disruption and measuring the target lesion's minimum lumen area (MLA) and minimum lumen diameter (MLD)); in-hospital cardiac death, acute stent thrombosis, and heart failure occurrences; and the one-year incidence of major adverse cardiovascular and cerebrovascular events (MACCE). Discussion The RACE study evaluates the impact of different rotational speeds in coronary rotational atherectomy, aiming to provide guidance for clinical practice. The findings may help standardize RA procedures and inform future clinical guidelines, improving procedural consistency and patient outcomes. Registration number ChiCTR2300076194, Registered 27 September 2023. rotational atherectomy high speed low speed vascular calcification Figures Figure 1 Introduction With the progression of socio-economic development and an aging population, the incidence of coronary heart disease (CHD) is steadily increasing. Against this backdrop, the issue of Coronary Artery Calcification (CAC) has become increasingly prominent, especially among middle-aged and older adults. Epidemiological data indicate that in adults aged 45 to 84, the prevalence of CAC can be as high as 70.4% [ 1 ]. Among patients undergoing Percutaneous Coronary Intervention (PCI), approximately 18–24% exhibit moderate to severe calcification [ 2 ]. Studies have shown that patients with severe CAC face a higher risk of major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infarction, target vessel revascularization, and in-stent thrombosis [ 3 – 7 ]. Therefore, effectively managing CAC is crucial for improving the outcomes of PCI. In recent years, with the increasing emphasis on "optimizing PCI", pre-procedural vessel preparation for PCI has garnered widespread attention. In this context, calcific lesions have become as a significant challenge in cardiovascular intervention. Despite advancements in PCI techniques, the presence of CAC remains a major barrier to both short-term and long-term success of treatments. Rotational atherectomy (RA) is a key technique for managing calcified coronary lesions, offering distinct clinical benefits. By modifying calcific plaques, facilitating stent delivery, and increasing the luminal area, RA enhances PCI success rates [ 8 ]. The PROTECT II trial studied RA in high-risk PCI and found that while essential for severe calcific lesions, it may also increase the risk of perioperative myocardial infarction [ 9 ]. Among procedural variables, burr rotation speed is considered a key determinant of both procedural outcomes and complication rates [ 10 ]. However, the optimal strategy for rotation speed remains undefined. Expert opinions on this issue vary across different regions and clinical practices [ 11 – 14 ]. Low-speed rotational atherectomy (LSRA) has been reported to reduce intraoperative slow flow, but the supporting evidence is inconsistent, and no consensus has been reached on its clinical benefits [ 15 – 17 ]. Recent studies have reported that a combination strategy of LSRA and high-speed RA (HSRA) is a safe and feasible approach for managing severely calcified lesions in clinical practice, yet its advantage over conventional methods remains unclear [ 18 ]. While LSRA following HSRA has been associated with greater lumen gain compared to continuous HSRA, conflicting findings exist, and its long-term impact is not well established [ 18 , 19 ]. Most existing studies are retrospective or observational, and large-scale trials on the optimal rotational speed for better procedural success and outcomes are lacking. Our previous retrospective studies have identified differences in perioperative outcomes among patients undergoing RA at different rotational speeds [ 10 , 20 ]. However, the optimal and safest burr rotation speed remains uncertain, highlighting the need for further prospective research to establish a standardized approach. To address this gap, the RACE trial aims to evaluate the safety and efficacy of different rotational speed protocols by analyzing their impact on perioperative complications and long-term prognosis in patients with CHD. Methods Study design This is a single-center, randomized controlled study focusing on patients with CHD who have significant CAC and are candidates for RA. The objective of the study is to examine differences in perioperative complications and long-term prognosis among various rotational speed protocols in these patients. We plan to continuously recruit participants at a tertiary A-grade hospital in Anhui, China, which is renowned for its large patient population with cardiovascular diseases and advanced medical technology. Patients who require RA treatment and meet the specific inclusion criteria (Table 1) will be enrolled in the study. Prior to undergoing RA, the Principal Investigator (PI) will verify patient eligibility and obtain written informed consent. Table 1 Eligible criteria Inclusion criteria · Age ≥ 18 years old; · The presence of severe coronary calcification was evaluated utilizing one of the following methods: CAC assessed as severe based on semi-quantitative scoring; IVUS detection of calcific lesions exceeding 270° in arc; IVUS identification of prominent calcific nodules protruding into the lumen; OCT assessment scoring calcification as 4 points; OCT identification of prominent calcific nodules protruding into the lumen; Inability of the balloon to pass or fully expand the lesion. Exclusion Criteria · Age > 80 years; · Severe left ventricular dysfunction [LVEF ≤ 30%]; · Lesions where the rotational atherectomy guidewire cannot pass; · Lesions rich in thrombus; · Venous bridge vascular lesions; · lesions with acute angles ≤90°； · Severe spiral dissection; · Immediate rotational atherectomy following stent placement; · Pregnant or breastfeeding women; · Anticipated lifespan < 1 year; · Inability to comply with follow-up. Lesions with acute angulation (≤90°) were excluded as studies have identified severe angulation as an independent predictor of procedural and clinical failure in RA [21]. Immediate RA following stent placement was excluded due to the high risk of burr entrapment and suboptimal long-term outcomes reported in previous studies [22-25]. CAC: Coronary Artery Calcification; OCT: Optical Coherence Tomography; IVUS: Intravascular Ultrasound; LVEF: Left Ventricular Ejection Fraction. It is anticipated that 210 patients who meet the inclusion and exclusion criteria will be randomly assigned in a 1:1:1 ratio to three different rotational speed groups: a continuous low-speed rotation (LSRA) group (140,000 rpm), a continuous high-speed rotation (HSRA) group (180,000 rpm), and a high-speed to low-speed rotation (HSRA+LSRA) group (initially 180,000 rpm, followed by 100,000 rpm). The study includes a 12-month follow-up period. Research protocols and documents have been distributed to relevant researchers. Recruitment began on October 1, 2023, and will continue until the estimated number of patients is reached, with the study expected to be completed within 3 years. This study protocol has been approved by the Medical Research Ethics Committee of the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital) under approval number 2023-KY-076. Randomization Eligible patients who provide informed consent will be randomly assigned in a 1:1:1 ratio to one of three rotational speed groups for RA treatment (Figure 1). To ensure unbiased random allocation, a computer-generated random number table was created prior to the commencement of the study. Patients will be assigned sequentially based on this table to one of three groups: LSRA, HSRA, or HSRA+LSRA, maintaining a 1:1:1 distribution to ensure group balance. Once a patient meets the inclusion criteria, the assigned study personnel will disclose the randomization result but will not be involved in data collection or follow-up. To minimize bias, outcome assessors will remain blinded to the treatment allocation. These assessors, responsible for evaluating primary and secondary endpoints, will not be aware of the specific intervention each patient receives. Randomization data will be securely stored and managed by an independent data management team, ensuring blinding until the completion of data analysis. This methodology ensures an objective assessment of the safety and efficacy of different RA rotational speed protocols, offering valuable insights for optimizing treatment strategies in coronary heart disease. Clinical procedures Our center utilizes the Siemens DTC (or PHILIPS FD1010) angiography system for coronary angiography and interventional therapy. The Rotablator System (Boston Scientific Corporation, Natick, MA, USA) was used for all the RA procedures. Prior to the procedure, patients were treated with aspirin (100 mg per day) and thienopyridine (clopidogrel 75 mg daily or ticagrelor 100 mg twice daily). In addition, normal heparin (70-100 units/kg) was administered intravenously during the procedure to achieve an appropriate activated clotting time (250 seconds). Percutaneous coronary intervention was performed at the operator's discretion. In previous studies[26], we observed that higher experience in RA might be linked to worse outcome in PCI via femoral approach in both stable angina and acute coronary syndrome settings. However, the specific approach should still be determined based on the characteristics of the patient's specific lesions and the conditions of the peripheral vascular pathways. Catheters up to 7 F in diameter were used to exchange a 0.009-inch (1 inch = 2.54 cm) rotating wire flexible disk to the distal end of the target lesion with the help of a Finecross or Crossair microcatheter. Each RA session lasted less than 30 seconds, with a 60-second interval between each RA. During the RA procedure, a continuous pressurized drip of plain heparin nitroglycerin flushing solution was administered. Noncompliant balloon dilation and stent placement were performed following the RA procedure, depending on the lesion characteristics. Patients who developed bradyarrhythmias after RA received both a strong cough and intravenous atropine. Atropine and a temporary pacemaker were prepared for patients with right coronary artery or systolic branch predominance. Implantation of intra-aortic balloon counter pulsation (IABP) depends on the judgment and guidance of the supervising cardiologist. Following the completion of rotational atherectomy, a follow-up coronary angiography was performed. In cases of vascular spasm, intracoronary nitroglycerin or sodium nitroprusside was administered via the catheter to relieve the spasm. This study will assess the effectiveness of coronary RA using IVUS and OCT, which provide detailed imaging of lesion structure and treatment outcomes. IVUS is a technique that uses high-frequency sound waves to visualize the inner walls of blood vessels[27]. IVUS utilizes high-frequency sound waves to visualize the inner walls of blood vessels, allowing us to accurately measure the degree of stenosis and the composition of the plaque. In this study, IVUS will assess intimal lumen diameter and plaque morphology before and after RA. This will help clarify how different rotational speeds affect the vessel wall and plaques. On the other hand, OCT uses near-infrared light to capture high-resolution images of the vessel lining[28]. OCT can provide higher resolution images than IVUS, especially in assessing intima and plaque surface characteristics. In this study, OCT will be used to assess endovascular surface features after RA treatment, including plaque tears, stenting effects, and possible vessel damage. By combining IVUS and OCT, we will be able to comprehensively evaluate the effects of RA treatment at both macroscopic and microscopic levels. This information will provide important clinical data for evaluating the safety and efficacy of different rotational speeds, thus contributing to optimize the use of RA in the treatment of coronary artery disease (CAD). Planned outcomes The primary focus of this study is to investigate the safety and efficacy of using different rotational speeds in coronary rotational atherectomy. The main endpoint is the incidence of complications during the atherectomy procedure. Secondary endpoints include assessments through intravascular imaging, in-hospital adverse cardiovascular events, and adverse cardiovascular events during the 1-year follow-up period (Table 2). Table 2 Primary endpoints Complications during RA Coronary Artery Spasm Slow Flow/ No Reflow Dissection Burr Entrapment Guidewire Fracture Perforation Secondary endpoints IVUS/OCT ： Adverse events MACCE ①Calcific Ring Disruption ②MLA ③MLD Cardiac Death Acute Stent Thrombosis Heart Failure Cardiac Death Non-fatal Myocardial Infarction Ischemia-Driven Revascularization TIA In IVUS, calcific ring disruption is defined as a loss of continuity in the calcified plaque, presenting as fissures, defects, or fractures along the plaque margins. In OCT, it is identified by cracks, defects, or fractures within the calcified region, resulting in surface irregularities or cavitations. RA：Rotational Atherectomy; MLA: Minimum Lumen Area of Target Lesion; MLD: Minimum Lumen Diameter of Target Lesion; TIA: Transient Ischemic Attack; MACCE: major adverse cardiovascular and cerebrovascular events; IVUS: Intravascular Ultrasound; OCT: Optical Coherence Tomography. Trial Schedule and follow up The follow-up plan includes both perioperative and long-term clinical outcomes (see Table 3). The clinical data to be collected will include preoperative baseline information, including demographic information, imaging studies (electrocardiogram, echocardiography), laboratory tests (including total platelet count, cardiac troponin I, and N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP)), medication history, as well as primary and secondary endpoint data. Follow-ups for all participants are scheduled at 12 months, during which both primary and secondary outcomes, as well as safety, will be assessed. Table 3 OCT: optical coherence tomography, IVUS: Intravascular Ultrasound, ECG: electrocardiography; RA: Rotational Atherectomy. Sample Size According to the literature, the probability of complications occurring during RA is 4%, 14% in the HSRA+LSRA group[18], and 24% at higher rotational speeds. A sample size of 175 achieves 80% power to detect an effect size (W) of 0.2353 using a 2-degree-of-freedom Chi-Square Test with a significance level of α= 0.05[29]. Considering a 15% dropout rate, the total required sample size is 210, with 70 participants per group. Statistical Analysis All data will be statistically analyzed using SPSS version 22.0. Quantitative data will be presented as mean ± standard deviation (±s), with intergroup comparisons made using independent sample t-tests. Categorical data will be presented as number (percentage) [n (%)], with intergroup comparisons using the χ² test. Logistic regression analysis will be applied to ascertain the correlation between coronary rotational speed and perioperative complications, as well as one-year MACCE. Considering potential data missing and loss to follow-up, we'll mainly use intention-to-treat (ITT) analysis and apply per-protocol (PP) dataset for sensitivity analysis. Besides, we'll preset some subgroup analyses (e.g., based on patient age groups or lesion complexity) to verify results' stability and explore special effect participants. To account for multiple comparisons, family-wise error rate (FWER) control methods will be applied where appropriate. Specifically, Bonferroni correction (adjusting the significance threshold to α’=0.025) and the Holm-Bonferroni procedure (a stepwise approach that improves statistical power while maintaining FWER control) will be used for primary analyses. To minimize unnecessary tests, only key comparisons (HSRA vs. LSRA; HSRA+LSRA vs. LSRA) will be included. When the sample size is limited, Holm’s method will be preferred over Bonferroni to optimize the balance between statistical power and error control. A P-value of <0.05 will be considered statistically significant. All statistical tests will be two-sided. Patient and public involvement This study is conducted without patient or public involvement in its design, execution, or analysis. Physicians will communicate the results to participants. Discussion The RACE study aims to compare perioperative complications and long-term outcomes in CAD patients. These patients will undergo different rotational speed protocols during RA. The study will also assess the safety and effectiveness of these different speed protocols. CAC is a common phenomenon in CAD, particularly prevalent among the elderly and those with chronic cardiovascular conditions. The presence of CAC complicates PCI, often reducing the effectiveness of traditional balloon angioplasty and stent placement. Approximately half of CAD patients exhibit some level of CAC, with up to 20% of those undergoing PCI presenting with moderate to severe calcification[ 30 , 31 ]. Such calcification is associated with an increased rate of MACCE, target lesion revascularization (TLR), and target vessel revascularization[ 32 – 34 ]. RA is widely recognized as an effective percutaneous treatment for severe calcified or fibrotic lesions unmanageable by traditional PCI. As RA technology has matured, the indications for PCI have expanded, enhancing the success rate of complex coronary interventions. However, RA can result in unique complications such as slow flow, burr entrapment, and vessel perforation, which are closely linked to patient morbidity and mortality rates. Among these, slow flow/no reflow is the most frequently observed complication following RA, as reported in previous studies. The reported incidence of slow flow/no reflow ranges from 2–27% [ 17 , 18 , 35 ]. The causes of complications are not fully understood, and research on how rotational speed affects outcomes is limited. This gap necessitates further investigation to optimize RA treatment strategies and minimize complications. Previous studies have shown that excessively high or low RA speeds can increase the risk of postoperative complications. For instance, high speeds might lead to overheating, endothelial damage, or platelet activation[ 16 ], while low speeds may be insufficient for effective calcific plaque removal. A randomized controlled trial [ 17 ] found no significant reduction in slow flow rates following low-speed RA compared to high-speed RA. A single-center, observational, retrospective study on patients with acute coronary syndrome (ACS) [ 10 ] divided patients into a low-speed group (130,000 to 150,000 rpm, 182 cases) and a high-speed group (160,000 to 220,000 rpm, 101 cases). The results showed a higher risk of vascular spasm in the low-speed ACS group and an increased risk of slow flow in the high-speed group. However, this study's small sample size and retrospective design limit its ability to fully confirm the results of randomized controlled trials. It is important to note that our study includes all types of coronary heart disease, but lesions rich in thrombus were excluded. Furthermore, our study focuses on patients with severe coronary artery calcification, who may respond differently to RA compared to ACS patients, providing a new perspective on how different speeds influence complications and outcomes. Besides postoperative complications, the impact of RA speeds on long-term patient outcomes is also a focal point of our study. Existing literature lacks studies on the long-term effects associated with different RA speeds. A retrospective study by Wu et al[ 20 ] revealed that there was no significant difference in 6-month outcomes between different speeds, but there suggested an increased risk of major adverse cardiac events and MACCE with higher speeds. To explore this further, our study extends the follow-up period to one year, aiming to gather more comprehensive and reliable data. The selection of rotational speeds in this study was based on current expert recommendations and clinical experience. Since no universally accepted optimal RA speed exists, guidelines vary in their recommendations [ 11 , 12 , 14 ]. For the hybrid approach, previous studies have used different protocols. Yamamoto et al. (190,000 → 110,000 rpm) and Kobayashi et al. (220,000 → 120,000 rpm) both found this strategy to be safe, though their results on lumen gain differed. Considering these differences, we selected 140,000 rpm, 180,000 rpm, and a hybrid approach to further assess how speed variations influence procedural success and clinical outcomes. This design enables a direct comparison between LSRA and HSRA while also examining the effects of speed transitions, particularly in complex calcified lesions. Moreover, the introduction of intravascular imaging offers insights into the mechanisms of stent failure, emphasizing the importance of optimal lesion preparation before stent implantation [ 36 ]. Our study utilizes IVUS and OCT to collect data on calcific ring disruption, MLA and MLD of target lesions, serving as safety assessment indicators. This study aims to explore how different rotational speeds affect the efficacy and clinical outcomes of RA. By systematically analyzing their impact, we hope to provide practical guidance for clinical decision-making and contribute to the standardization of RA procedures. The findings may serve as a reference for future clinical guidelines, helping to establish more consistent treatment strategies. Ultimately, standardization could improve procedural predictability and patient outcomes over the long term. Limitations Our study has several limitations. First, it was conducted at a single medical center, which may limit the generalizability of the results. Studies conducted at different centers may yield varied outcomes due to regional differences, demographic characteristics, and available treatment facilities. Second, despite our efforts to maintain consistency in the rotational atherectomy (RA) procedure, some variability in operation remains. For example, interventional cardiologists may use different burr advancement techniques, such as rapid or slow pecking, which could impact treatment outcomes. Finally, the skill level and experience of the operators could significantly influence the study's results. Variations in operator expertise and experience may lead to inconsistencies in treatment effectiveness. To address this, standardized procedural protocols, operator training, and quality control measures have been implemented to ensure greater consistency. Dissemination Plan We plan to disseminate the findings of this study through multiple channels. This includes publishing articles in peer-reviewed academic journals, presenting at relevant academic conferences, and engaging with the public, policymakers, and healthcare professionals. Additionally, we will share updates on the research progress via social media and other online platforms to facilitate the exchange and application of scientific knowledge. Efforts will be made to ensure broad dissemination of the research outcomes, with the goal of positively impacting society. Trial status The current protocol version 2.1 was issued on September 22, 2024. The recruitment started with the first patient included on 1 October 2023. At the submission of this manuscript on 22 September 2024, 132 patients have been included and randomized. Recruitment is ongoing and should be completed by December 2025. Abbreviations CHD Coronary Heart Disease CAC Coronary Artery Calcification HSRA High-Speed Rotation IVUS Intravascular Ultrasound LSRA Low-Speed Rotation LVEF Left Ventricular Ejection Fraction MLA Minimum Lumen Area MLD Minimum Lumen Diameter MACCE Major Adverse Cardiovascular and Cerebrovascular Event OCT Optical Coherence Tomography PCI Percutaneous Coronary Interventions RA Rotational Atherectomy Declarations Acknowledgements We would like to thank all the healthcare professionals and patients who participated in the RACE study. We also extend our gratitude to the patient advisors who provided feedback on the protocol proposal Author Contributions J.W.W. conceptualized and designed the study and contributed to manuscript editing. J.X. participated in study design, conducted the trial analysis analyzed and interpreted data, and drafted the manuscript. Yu-wei Wang, Li-Kun Ma, Hao Hu, Hong-Wu Chen, Jing-Sheng Hua, Xiang-Yong Kong, Dan Li, Long-Wei Li, Jian-Yuan Pan performed the trial and contributed to data analysis. Funding This study received financial support from the Natural Science Foundation of Hefei City (2022043), the National Natural Science Foundation of China (82200282), National Key Research and Development Program of China (2021YFA0804904), and the Clinical Medical Research Transformation Project of Anhui Province (Grant No. 202204295107020021, 202204295107020026). Availability of data and materials The datasets analyzed during the current study and statistical code will be available from the corresponding author on reasonable request, as is the full protocol. Ethics approval and consent to participate This study was approved by the Medical Research Ethics Committee of the First Affiliated Hospital of the University of Science and Technology of China (Approval Number: 2023-KY-076). All participants provided written informed consent prior to participation. Participant confidentiality and data anonymity were rigorously maintained throughout the study. We plan to establish an independent DSMB for this study to ensure patient safety and review any adverse events that may arise during the research process. Consent for publication Not applicable. Competing Interest statement The authors declare that they have no competing interests. References Bild, D.E., et al., Ethnic differences in coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation, 2005. 111 (10): p. 1313-20. Angsubhakorn, N., et al., Contemporary Management of Severely Calcified Coronary Lesions. J Pers Med, 2022. 12 (10). 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Supplementary Files funding.pdf Cite Share Download PDF Status: Published Journal Publication published 08 Apr, 2025 Read the published version in Trials → Version 1 posted Editorial decision: Accept 02 Apr, 2025 Reviewers agreed at journal 23 Mar, 2025 Reviewers invited by journal 23 Mar, 2025 Editor assigned by journal 21 Mar, 2025 First submitted to journal 20 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5129794","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":432609621,"identity":"99e19238-ef1f-448d-9b0d-af182e115bf9","order_by":0,"name":"Jie Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYHCChANgir0BSBhYkKKFB0QZSJBimUQCmCSs0OBGwsMDH9ts8vlnPr+64UeBBAN/e3cCXi2SMxISDs5sS7OccTun7GYP0GESZ85uwKuFXyIh4TDPmcMGDLdz0m7wALUYSOTi18IG0vLnzH8D+Ztn0m7+IUYL2BaGigMGBjfYj90myhbJngcJB3sqkg0Mz+Sw3ZYxkOAh6BeD4znJH34Y2BnIHT/+7OabPzZy/O29+LUAozABxjAAkwSUgwD7ARjjARGqR8EoGAWjYCQCAAdVS18RNuuqAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0007-4918-0953","institution":"The First Affiliated Hospital of USTC: Anhui Provincial Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jie","middleName":"","lastName":"Xu","suffix":""},{"id":432609622,"identity":"fd6a4385-9f21-4451-8822-37f67fbe681c","order_by":1,"name":"Yuwei Wang","email":"","orcid":"","institution":"The First Affiliated Hospital of USTC: Anhui Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuwei","middleName":"","lastName":"Wang","suffix":""},{"id":432609623,"identity":"66baf519-e7b3-45a7-9486-fc29a476848a","order_by":2,"name":"Jiawei Wu","email":"","orcid":"","institution":"The First Affiliated Hospital of USTC: Anhui Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiawei","middleName":"","lastName":"Wu","suffix":""},{"id":432609624,"identity":"133b3c37-6338-4c61-8c1f-96c4496326c2","order_by":3,"name":"Li-Kun Ma","email":"","orcid":"","institution":"The First Affiliated Hospital of USTC: Anhui Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Li-Kun","middleName":"","lastName":"Ma","suffix":""},{"id":432609625,"identity":"701927e2-b208-4c76-9ff7-c6f2fd7914d4","order_by":4,"name":"Hao Hu","email":"","orcid":"","institution":"The First Affiliated Hospital of USTC: Anhui Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Hu","suffix":""},{"id":432609626,"identity":"5ddee094-626f-4ae5-838c-f10f463a42dd","order_by":5,"name":"Hong-Wu Chen","email":"","orcid":"","institution":"The First Affiliated Hospital of USTC: Anhui Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hong-Wu","middleName":"","lastName":"Chen","suffix":""},{"id":432609627,"identity":"08b632d7-eb43-4ea7-bfbe-98c83390ce3e","order_by":6,"name":"Jing-Sheng Hua","email":"","orcid":"","institution":"The First Affiliated Hospital of USTC: Anhui Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jing-Sheng","middleName":"","lastName":"Hua","suffix":""},{"id":432609628,"identity":"521cb0e7-23db-45f6-add5-d014fee5d15b","order_by":7,"name":"Xiang-Yong Kong","email":"","orcid":"","institution":"The First Affiliated Hospital of USTC: Anhui Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiang-Yong","middleName":"","lastName":"Kong","suffix":""},{"id":432609629,"identity":"bbd4ff73-c3da-4fa5-bd3f-cb514b55e5f3","order_by":8,"name":"Dan Li","email":"","orcid":"","institution":"The First Affiliated Hospital of USTC: Anhui Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dan","middleName":"","lastName":"Li","suffix":""},{"id":432609630,"identity":"344fb961-7642-43fb-93d3-383fac5257e6","order_by":9,"name":"Long-Wei Li","email":"","orcid":"","institution":"The First Affiliated Hospital of USTC: Anhui Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Long-Wei","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2024-09-21 17:55:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5129794/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5129794/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13063-025-08834-6","type":"published","date":"2025-04-08T16:05:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79259278,"identity":"37aa22d1-94ca-4985-a3da-4cad8519febc","added_by":"auto","created_at":"2025-03-26 09:18:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":99916,"visible":true,"origin":"","legend":"\u003cp\u003eLSRA: Low-speed rotation, HSRA: high-speed rotation, HSRA+LSRA: a high-speed to low-speed rotation, OCT: optical coherence tomography, IVUS: Intravascular Ultrasound, PCI: Percutaneous\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5129794/v1/514177d1cdecc669c3ab92a7.png"},{"id":80558318,"identity":"20c06f89-ed1b-4928-8026-7bcb7d261415","added_by":"auto","created_at":"2025-04-14 16:14:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":857609,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5129794/v1/a2f502f1-3200-46f3-9233-34d8aabaf1c5.pdf"},{"id":79258397,"identity":"a15bfeba-19e5-4787-9bfd-d589c073bccc","added_by":"auto","created_at":"2025-03-26 09:10:51","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":150567,"visible":true,"origin":"","legend":"","description":"","filename":"funding.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5129794/v1/1d645ca3730ea8c13e3d1c10.pdf"}],"financialInterests":"","formattedTitle":"Safety and Efficacy of Different Rotational Speed during Rotational Atherectomy in Coronary Heart Disease Patients (RACE): study protocol for a randomized controlled trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the progression of socio-economic development and an aging population, the incidence of coronary heart disease (CHD) is steadily increasing. Against this backdrop, the issue of Coronary Artery Calcification (CAC) has become increasingly prominent, especially among middle-aged and older adults. Epidemiological data indicate that in adults aged 45 to 84, the prevalence of CAC can be as high as 70.4% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Among patients undergoing Percutaneous Coronary Intervention (PCI), approximately 18\u0026ndash;24% exhibit moderate to severe calcification [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Studies have shown that patients with severe CAC face a higher risk of major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infarction, target vessel revascularization, and in-stent thrombosis [\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, effectively managing CAC is crucial for improving the outcomes of PCI.\u003c/p\u003e \u003cp\u003eIn recent years, with the increasing emphasis on \"optimizing PCI\", pre-procedural vessel preparation for PCI has garnered widespread attention. In this context, calcific lesions have become as a significant challenge in cardiovascular intervention. Despite advancements in PCI techniques, the presence of CAC remains a major barrier to both short-term and long-term success of treatments. Rotational atherectomy (RA) is a key technique for managing calcified coronary lesions, offering distinct clinical benefits. By modifying calcific plaques, facilitating stent delivery, and increasing the luminal area, RA enhances PCI success rates [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The PROTECT II trial studied RA in high-risk PCI and found that while essential for severe calcific lesions, it may also increase the risk of perioperative myocardial infarction [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Among procedural variables, burr rotation speed is considered a key determinant of both procedural outcomes and complication rates [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, the optimal strategy for rotation speed remains undefined. Expert opinions on this issue vary across different regions and clinical practices [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Low-speed rotational atherectomy (LSRA) has been reported to reduce intraoperative slow flow, but the supporting evidence is inconsistent, and no consensus has been reached on its clinical benefits [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Recent studies have reported that a combination strategy of LSRA and high-speed RA (HSRA) is a safe and feasible approach for managing severely calcified lesions in clinical practice, yet its advantage over conventional methods remains unclear [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. While LSRA following HSRA has been associated with greater lumen gain compared to continuous HSRA, conflicting findings exist, and its long-term impact is not well established [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Most existing studies are retrospective or observational, and large-scale trials on the optimal rotational speed for better procedural success and outcomes are lacking.\u003c/p\u003e \u003cp\u003eOur previous retrospective studies have identified differences in perioperative outcomes among patients undergoing RA at different rotational speeds [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, the optimal and safest burr rotation speed remains uncertain, highlighting the need for further prospective research to establish a standardized approach.\u003c/p\u003e \u003cp\u003eTo address this gap, the RACE trial aims to evaluate the safety and efficacy of different rotational speed protocols by analyzing their impact on perioperative complications and long-term prognosis in patients with CHD.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a single-center, randomized controlled study focusing on patients with CHD who have significant CAC and are candidates for RA. The objective of the study is to examine differences in perioperative complications and long-term prognosis among various rotational speed protocols in these patients. We plan to continuously recruit participants at a tertiary A-grade hospital in Anhui, China, which is renowned for its large patient population with cardiovascular diseases and advanced medical technology. Patients who require RA treatment and meet the specific inclusion criteria (Table 1) will be enrolled in the study. Prior to undergoing RA, the Principal Investigator (PI) will verify patient eligibility and obtain written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEligible criteria\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 554px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026middot;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAge \u0026ge; 18 years old;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026middot;\u003c/strong\u003e The presence of severe coronary calcification was evaluated utilizing one of the following methods:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003eCAC assessed as severe based on semi-quantitative scoring;\u003c/li\u003e\n \u003cli\u003eIVUS detection of calcific lesions exceeding 270\u0026deg; in arc;\u003c/li\u003e\n \u003cli\u003eIVUS identification of prominent calcific nodules protruding into the lumen;\u003c/li\u003e\n \u003cli\u003eOCT assessment scoring calcification as 4 points;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOCT identification of prominent calcific nodules protruding into the lumen;\u003c/li\u003e\n \u003cli\u003eInability of the balloon to pass or fully expand the lesion.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 554px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026middot;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAge \u0026gt; 80 years;\u003c/p\u003e\n \u003cp\u003e\u0026middot; Severe left ventricular dysfunction [LVEF \u0026le; 30%];\u003c/p\u003e\n \u003cp\u003e\u0026middot; Lesions where the rotational atherectomy guidewire cannot pass;\u003c/p\u003e\n \u003cp\u003e\u0026middot; Lesions rich in thrombus;\u003c/p\u003e\n \u003cp\u003e\u0026middot; Venous bridge vascular lesions;\u003c/p\u003e\n \u003cp\u003e\u0026middot; lesions with acute angles \u0026le;90\u0026deg;；\u003c/p\u003e\n \u003cp\u003e\u0026middot; Severe spiral dissection;\u003c/p\u003e\n \u003cp\u003e\u0026middot; Immediate rotational atherectomy following stent placement;\u003c/p\u003e\n \u003cp\u003e\u0026middot; Pregnant or breastfeeding women;\u003c/p\u003e\n \u003cp\u003e\u0026middot; Anticipated lifespan \u0026lt; 1 year;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026middot;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eInability to comply with follow-up.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eLesions with acute angulation (\u0026le;90\u0026deg;) were excluded as studies have identified severe angulation as an independent predictor of procedural and clinical failure in RA [21]. Immediate RA following stent placement was excluded due to the high risk of burr entrapment and suboptimal long-term outcomes reported in previous studies [22-25]. CAC: Coronary Artery Calcification; OCT: Optical Coherence Tomography; IVUS: Intravascular Ultrasound; LVEF: Left Ventricular Ejection Fraction.\u003c/p\u003e\n\u003cp\u003eIt is anticipated that 210 patients who meet the inclusion and exclusion criteria will be randomly assigned in a 1:1:1 ratio to three different rotational speed groups: a continuous low-speed rotation (LSRA) group (140,000 rpm), a continuous high-speed rotation (HSRA) group (180,000 rpm), and a high-speed to low-speed rotation (HSRA+LSRA) group (initially 180,000 rpm, followed by 100,000 rpm). The study includes a 12-month follow-up period. Research protocols and documents have been distributed to relevant researchers. Recruitment began on October 1, 2023, and will continue until the estimated number of patients is reached, with the study expected to be completed within 3 years.\u003c/p\u003e\n\u003cp\u003eThis study protocol has been approved by the Medical Research Ethics Committee of the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital) under approval number 2023-KY-076.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRandomization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEligible patients who provide informed consent will be randomly assigned in a 1:1:1 ratio to one of three rotational speed groups for RA treatment (Figure 1). To ensure unbiased random allocation, a computer-generated random number table was created prior to the commencement of the study. Patients will be assigned sequentially based on this table to one of three groups: LSRA, HSRA, or HSRA+LSRA, maintaining a 1:1:1 distribution to ensure group balance. Once a patient meets the inclusion criteria, the assigned study personnel will disclose the randomization result but will not be involved in data collection or follow-up. To minimize bias, outcome assessors will remain blinded to the treatment allocation. These assessors, responsible for evaluating primary and secondary endpoints, will not be aware of the specific intervention each patient receives. Randomization data will be securely stored and managed by an independent data management team, ensuring blinding until the completion of data analysis. This methodology ensures an objective assessment of the safety and efficacy of different RA rotational speed protocols, offering valuable insights for optimizing treatment strategies in coronary heart disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical procedures\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur center utilizes the Siemens DTC (or PHILIPS FD1010) angiography system for coronary angiography and interventional therapy. The Rotablator System (Boston Scientific Corporation, Natick, MA, USA) was used for all the RA procedures. \u0026nbsp;Prior to the procedure, patients were treated with aspirin (100 mg per day) and thienopyridine (clopidogrel 75 mg daily or ticagrelor 100 mg twice daily). In addition, normal heparin (70-100 units/kg) was administered intravenously during the procedure to achieve an appropriate activated clotting time (250 seconds). Percutaneous coronary intervention was performed at the operator\u0026apos;s discretion. In previous studies[26], we observed that higher experience in RA might be linked to worse outcome in PCI via femoral approach in both stable angina and acute coronary syndrome settings. However, the specific approach should still be determined based on the characteristics of the patient\u0026apos;s specific lesions and the conditions of the peripheral vascular pathways. Catheters up to 7 F in diameter were used to exchange a 0.009-inch (1 inch = 2.54 cm) rotating wire flexible disk to the distal end of the target lesion with the help of a Finecross or Crossair microcatheter. Each RA session lasted less than 30 seconds, with a 60-second interval between each RA. During the RA procedure, a continuous pressurized drip of plain heparin nitroglycerin flushing solution was administered. Noncompliant balloon dilation and stent placement were performed following the RA procedure, depending on the lesion characteristics. Patients who developed bradyarrhythmias after RA received both a strong cough and intravenous atropine. Atropine and a temporary pacemaker were prepared for patients with right coronary artery or systolic branch predominance. Implantation of intra-aortic balloon counter pulsation (IABP) depends on the judgment and guidance of the supervising cardiologist. Following the completion of rotational atherectomy, a follow-up coronary angiography was performed. In cases of vascular spasm, intracoronary nitroglycerin or sodium nitroprusside was administered via the catheter to relieve the spasm.\u003c/p\u003e\n\u003cp\u003eThis study will assess the effectiveness of coronary RA using IVUS and OCT, which provide detailed imaging of lesion structure and treatment outcomes. IVUS is a technique that uses high-frequency sound waves to visualize the inner walls of blood vessels[27].\u0026nbsp;IVUS utilizes high-frequency sound waves to visualize the inner walls of blood vessels, allowing us to accurately measure the degree of stenosis and the composition of the plaque. In this study, IVUS will assess intimal lumen diameter and plaque morphology before and after RA. This will help clarify how different rotational speeds affect the vessel wall and plaques. On the other hand, OCT uses near-infrared light to capture high-resolution images of the vessel lining[28]. OCT can provide higher resolution images than IVUS, especially in assessing intima and plaque surface characteristics. In this study, OCT will be used to assess endovascular surface features after RA treatment, including plaque tears, stenting effects, and possible vessel damage. By combining IVUS and OCT, we will be able to comprehensively evaluate the effects of RA treatment at both macroscopic and microscopic levels. This information will provide important clinical data for evaluating the safety and efficacy of different rotational speeds, thus contributing to optimize the use of RA in the treatment of coronary artery disease (CAD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePlanned outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary focus of this study is to investigate the safety and efficacy of using different rotational speeds in coronary rotational atherectomy. The main endpoint is the incidence of complications during the atherectomy procedure. Secondary endpoints include assessments through intravascular imaging, in-hospital adverse cardiovascular events, and adverse cardiovascular events during the 1-year follow-up period (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 554px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary endpoints\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications during RA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCoronary Artery Spasm\u003c/p\u003e\n \u003cp\u003eSlow Flow/ No Reflow\u003c/p\u003e\n \u003cp\u003eDissection\u003c/p\u003e\n \u003cp\u003eBurr Entrapment\u003c/p\u003e\n \u003cp\u003eGuidewire Fracture\u003c/p\u003e\n \u003cp\u003ePerforation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 554px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary endpoints\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIVUS/OCT\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAdverse events\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMACCE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e①Calcific Ring Disruption\u003c/p\u003e\n \u003cp\u003e②MLA\u003c/p\u003e\n \u003cp\u003e③MLD\u003c/p\u003e\n \u003cp\u003eCardiac Death\u003c/p\u003e\n \u003cp\u003eAcute Stent Thrombosis\u003c/p\u003e\n \u003cp\u003eHeart Failure\u003c/p\u003e\n \u003cp\u003eCardiac Death\u003c/p\u003e\n \u003cp\u003eNon-fatal Myocardial Infarction\u003c/p\u003e\n \u003cp\u003eIschemia-Driven Revascularization\u003c/p\u003e\n \u003cp\u003eTIA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn IVUS, calcific ring disruption is defined as a loss of continuity in the calcified plaque, presenting as fissures, defects, or fractures along the plaque margins. In OCT, it is identified by cracks, defects, or fractures within the calcified region, resulting in surface irregularities or cavitations. RA：Rotational Atherectomy; MLA: Minimum Lumen Area of Target Lesion; MLD: Minimum Lumen Diameter of Target Lesion; TIA: Transient Ischemic Attack; MACCE: major adverse cardiovascular and cerebrovascular events; IVUS: Intravascular Ultrasound; OCT: Optical Coherence Tomography.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Schedule and follow up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe follow-up plan includes both perioperative and long-term clinical outcomes (see Table 3). The clinical data to be collected will include preoperative baseline information, including demographic information, imaging studies (electrocardiogram, echocardiography), laboratory tests (including total platelet count, cardiac troponin I, and N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP)), medication history, as well as primary and secondary endpoint data. Follow-ups for all participants are scheduled at 12 months, during which both primary and secondary outcomes, as well as safety, will be assessed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cimg 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\"\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eOCT: optical coherence tomography, IVUS: Intravascular Ultrasound, ECG: electrocardiography; RA: Rotational Atherectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the literature, the probability of complications occurring during RA is 4%, 14% in the HSRA+LSRA group[18], and 24% at higher rotational speeds. A sample size of 175 achieves 80% power to detect an effect size (W) of 0.2353 using a 2-degree-of-freedom Chi-Square Test with a significance level of \u0026alpha;= 0.05[29]. \u0026nbsp;Considering a 15% dropout rate, the total required sample size is 210, with 70 participants per group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data will be statistically analyzed using SPSS version 22.0. Quantitative data will be presented as mean \u0026plusmn; standard deviation (\u0026plusmn;s), with intergroup comparisons made using independent sample t-tests. Categorical data will be presented as number (percentage) [n (%)], with intergroup comparisons using the \u0026chi;\u0026sup2; test. Logistic regression analysis will be applied to ascertain the correlation between coronary rotational speed and perioperative complications, as well as one-year MACCE. Considering potential data missing and loss to follow-up, we\u0026apos;ll mainly use intention-to-treat (ITT) analysis and apply per-protocol (PP) dataset for sensitivity analysis. Besides, we\u0026apos;ll preset some subgroup analyses (e.g., based on patient age groups or lesion complexity) to verify results\u0026apos; stability and explore special effect participants. To account for multiple comparisons, family-wise error rate (FWER) control methods will be applied where appropriate. Specifically, Bonferroni correction (adjusting the significance threshold to\u0026nbsp;\u0026alpha;\u0026rsquo;=0.025) and the Holm-Bonferroni procedure (a stepwise approach that improves statistical power while maintaining FWER control) will be used for primary analyses. To minimize unnecessary tests, only key comparisons (HSRA vs. LSRA; HSRA+LSRA vs. LSRA) will be included. When the sample size is limited, Holm\u0026rsquo;s method will be preferred over Bonferroni to optimize the balance between statistical power and error control.\u0026nbsp;A P-value of \u0026lt;0.05 will be considered statistically significant. All statistical tests will be two-sided.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient and public involvement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is conducted without patient or public involvement in its design, execution, or analysis. Physicians will communicate the results to participants.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe RACE study aims to compare perioperative complications and long-term outcomes in CAD patients. These patients will undergo different rotational speed protocols during RA. The study will also assess the safety and effectiveness of these different speed protocols.\u003c/p\u003e \u003cp\u003eCAC is a common phenomenon in CAD, particularly prevalent among the elderly and those with chronic cardiovascular conditions. The presence of CAC complicates PCI, often reducing the effectiveness of traditional balloon angioplasty and stent placement. Approximately half of CAD patients exhibit some level of CAC, with up to 20% of those undergoing PCI presenting with moderate to severe calcification[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Such calcification is associated with an increased rate of MACCE, target lesion revascularization (TLR), and target vessel revascularization[\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. RA is widely recognized as an effective percutaneous treatment for severe calcified or fibrotic lesions unmanageable by traditional PCI. As RA technology has matured, the indications for PCI have expanded, enhancing the success rate of complex coronary interventions. However, RA can result in unique complications such as slow flow, burr entrapment, and vessel perforation, which are closely linked to patient morbidity and mortality rates. Among these, slow flow/no reflow is the most frequently observed complication following RA, as reported in previous studies. The reported incidence of slow flow/no reflow ranges from 2\u0026ndash;27% [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The causes of complications are not fully understood, and research on how rotational speed affects outcomes is limited. This gap necessitates further investigation to optimize RA treatment strategies and minimize complications.\u003c/p\u003e \u003cp\u003ePrevious studies have shown that excessively high or low RA speeds can increase the risk of postoperative complications. For instance, high speeds might lead to overheating, endothelial damage, or platelet activation[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], while low speeds may be insufficient for effective calcific plaque removal. A randomized controlled trial [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] found no significant reduction in slow flow rates following low-speed RA compared to high-speed RA. A single-center, observational, retrospective study on patients with acute coronary syndrome (ACS) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] divided patients into a low-speed group (130,000 to 150,000 rpm, 182 cases) and a high-speed group (160,000 to 220,000 rpm, 101 cases). The results showed a higher risk of vascular spasm in the low-speed ACS group and an increased risk of slow flow in the high-speed group. However, this study's small sample size and retrospective design limit its ability to fully confirm the results of randomized controlled trials. It is important to note that our study includes all types of coronary heart disease, but lesions rich in thrombus were excluded. Furthermore, our study focuses on patients with severe coronary artery calcification, who may respond differently to RA compared to ACS patients, providing a new perspective on how different speeds influence complications and outcomes.\u003c/p\u003e \u003cp\u003eBesides postoperative complications, the impact of RA speeds on long-term patient outcomes is also a focal point of our study. Existing literature lacks studies on the long-term effects associated with different RA speeds. A retrospective study by Wu et al[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] revealed that there was no significant difference in 6-month outcomes between different speeds, but there suggested an increased risk of major adverse cardiac events and MACCE with higher speeds. To explore this further, our study extends the follow-up period to one year, aiming to gather more comprehensive and reliable data.\u003c/p\u003e \u003cp\u003eThe selection of rotational speeds in this study was based on current expert recommendations and clinical experience. Since no universally accepted optimal RA speed exists, guidelines vary in their recommendations [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. For the hybrid approach, previous studies have used different protocols. Yamamoto et al. (190,000 \u0026rarr; 110,000 rpm) and Kobayashi et al. (220,000 \u0026rarr; 120,000 rpm) both found this strategy to be safe, though their results on lumen gain differed. Considering these differences, we selected 140,000 rpm, 180,000 rpm, and a hybrid approach to further assess how speed variations influence procedural success and clinical outcomes. This design enables a direct comparison between LSRA and HSRA while also examining the effects of speed transitions, particularly in complex calcified lesions.\u003c/p\u003e \u003cp\u003eMoreover, the introduction of intravascular imaging offers insights into the mechanisms of stent failure, emphasizing the importance of optimal lesion preparation before stent implantation [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Our study utilizes IVUS and OCT to collect data on calcific ring disruption, MLA and MLD of target lesions, serving as safety assessment indicators.\u003c/p\u003e \u003cp\u003eThis study aims to explore how different rotational speeds affect the efficacy and clinical outcomes of RA. By systematically analyzing their impact, we hope to provide practical guidance for clinical decision-making and contribute to the standardization of RA procedures. The findings may serve as a reference for future clinical guidelines, helping to establish more consistent treatment strategies. Ultimately, standardization could improve procedural predictability and patient outcomes over the long term.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eOur study has several limitations. First, it was conducted at a single medical center, which may limit the generalizability of the results. Studies conducted at different centers may yield varied outcomes due to regional differences, demographic characteristics, and available treatment facilities. Second, despite our efforts to maintain consistency in the rotational atherectomy (RA) procedure, some variability in operation remains. For example, interventional cardiologists may use different burr advancement techniques, such as rapid or slow pecking, which could impact treatment outcomes. Finally, the skill level and experience of the operators could significantly influence the study's results. Variations in operator expertise and experience may lead to inconsistencies in treatment effectiveness. To address this, standardized procedural protocols, operator training, and quality control measures have been implemented to ensure greater consistency.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDissemination Plan\u003c/h2\u003e \u003cp\u003eWe plan to disseminate the findings of this study through multiple channels. This includes publishing articles in peer-reviewed academic journals, presenting at relevant academic conferences, and engaging with the public, policymakers, and healthcare professionals. Additionally, we will share updates on the research progress via social media and other online platforms to facilitate the exchange and application of scientific knowledge. Efforts will be made to ensure broad dissemination of the research outcomes, with the goal of positively impacting society.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTrial status\u003c/h2\u003e \u003cp\u003eThe current protocol version 2.1 was issued on September 22, 2024. The recruitment started with the first patient included on 1 October 2023. At the submission of this manuscript on 22 September 2024, 132 patients have been included and randomized. Recruitment is ongoing and should be completed by December 2025.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCHD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCoronary Heart Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCAC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCoronary Artery Calcification\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHSRA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHigh-Speed Rotation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIVUS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntravascular Ultrasound\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLSRA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow-Speed Rotation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLVEF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLeft Ventricular Ejection Fraction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMLA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinimum Lumen Area\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMLD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinimum Lumen Diameter\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMACCE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMajor Adverse Cardiovascular and Cerebrovascular Event\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOptical Coherence Tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePercutaneous Coronary Interventions\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRotational Atherectomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the healthcare professionals and patients who participated in the RACE study. We also extend our gratitude to the patient advisors who provided feedback on the protocol proposal\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJ.W.W. conceptualized and designed the study and contributed to manuscript editing. J.X. participated in study design, conducted the trial analysis analyzed and interpreted data, and drafted the manuscript. Yu-wei Wang, Li-Kun Ma, Hao Hu, Hong-Wu Chen, Jing-Sheng Hua, Xiang-Yong Kong, Dan Li, Long-Wei Li, Jian-Yuan Pan performed the trial and contributed to data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received financial support from the Natural Science Foundation of Hefei City (2022043), the National Natural Science Foundation of China (82200282), National Key Research and Development Program of China (2021YFA0804904), and the Clinical Medical Research Transformation Project of Anhui Province (Grant No. 202204295107020021, 202204295107020026).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study and statistical code will be available from the corresponding author on reasonable request, as is the full protocol.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Medical Research Ethics Committee of the First Affiliated Hospital of the University of Science and Technology of China (Approval Number: 2023-KY-076). All participants provided written informed consent prior to participation. Participant confidentiality and data anonymity were rigorously maintained throughout the study. We plan to establish an independent DSMB for this study to ensure patient safety and review any adverse events that may arise during the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBild, D.E., et al., \u003cem\u003eEthnic differences in coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA).\u003c/em\u003e Circulation, 2005. \u003cstrong\u003e111\u003c/strong\u003e(10): p. 1313-20.\u003c/li\u003e\n \u003cli\u003eAngsubhakorn, N., et al., \u003cem\u003eContemporary Management of Severely Calcified Coronary Lesions.\u003c/em\u003e J Pers Med, 2022. \u003cstrong\u003e12\u003c/strong\u003e(10).\u003c/li\u003e\n \u003cli\u003eKobayashi, Y., et al., \u003cem\u003eImpact of target lesion coronary calcification on stent expansion.\u003c/em\u003e Circ J, 2014. \u003cstrong\u003e78\u003c/strong\u003e(9): p. 2209-14.\u003c/li\u003e\n \u003cli\u003eFitzgerald, P.J., T.A. 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An observational study using intravascular ultrasound.\u003c/em\u003e Circulation, 1992. \u003cstrong\u003e86\u003c/strong\u003e(1): p. 64-70.\u003c/li\u003e\n \u003cli\u003eMosseri, M., et al., \u003cem\u003eImpact of vessel calcification on outcomes after coronary stenting.\u003c/em\u003e Cardiovasc Revasc Med, 2005. \u003cstrong\u003e6\u003c/strong\u003e(4): p. 147-53.\u003c/li\u003e\n \u003cli\u003eHuisman, J., et al., \u003cem\u003eImpact of severe lesion calcification on clinical outcome of patients with stable angina, treated with newer generation permanent polymer-coated drug-eluting stents: A patient-level pooled analysis from TWENTE and DUTCH PEERS (TWENTE II).\u003c/em\u003e Am Heart J, 2016. \u003cstrong\u003e175\u003c/strong\u003e: p. 121-9.\u003c/li\u003e\n \u003cli\u003eLasala, J.M., et al., \u003cem\u003eDrug-eluting stent thrombosis in routine clinical practice: two-year outcomes and predictors from the TAXUS ARRIVE registries.\u003c/em\u003e Circ Cardiovasc Interv, 2009. \u003cstrong\u003e2\u003c/strong\u003e(4): p. 285-93.\u003c/li\u003e\n \u003cli\u003eUetani, T. and T. Amano, \u003cem\u003eCurrent Status of Rotational Atherectomy in the Drug-Eluting Stent Era.\u003c/em\u003e Circ J, 2018. \u003cstrong\u003e82\u003c/strong\u003e(4): p. 946-947.\u003c/li\u003e\n \u003cli\u003eCohen, M.G., et al., \u003cem\u003eOptimizing rotational atherectomy in high-risk percutaneous coronary interventions: insights from the PROTECT \u0026Iota;\u0026Iota; study.\u003c/em\u003e Catheter Cardiovasc Interv, 2014. \u003cstrong\u003e83\u003c/strong\u003e(7): p. 1057-64.\u003c/li\u003e\n \u003cli\u003eWu, J., et al., \u003cem\u003eThe Incidence of Complication in the Perioperative Period of Rotational Atherectomy in Patients With Acute Coronary Syndrome: A Retrospective Study of Low Speed Versus High Speed.\u003c/em\u003e Am J Cardiol, 2023. \u003cstrong\u003e207\u003c/strong\u003e: p. 121-129.\u003c/li\u003e\n \u003cli\u003eBarbato, E., et al., \u003cem\u003eEuropean expert consensus on rotational atherectomy.\u003c/em\u003e EuroIntervention, 2015. \u003cstrong\u003e11\u003c/strong\u003e(1): p. 30-6.\u003c/li\u003e\n \u003cli\u003eSakakura, K., et al., \u003cem\u003eClinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023.\u003c/em\u003e Cardiovasc Interv Ther, 2023. \u003cstrong\u003e38\u003c/strong\u003e(2): p. 141-162.\u003c/li\u003e\n \u003cli\u003eSharma, S.K., et al., \u003cem\u003eNorth American Expert Review of Rotational Atherectomy.\u003c/em\u003e Circ Cardiovasc Interv, 2019. \u003cstrong\u003e12\u003c/strong\u003e(5): p. e007448.\u003c/li\u003e\n \u003cli\u003eGe JP., et al., Chinese expert consensus on rotational atherectomy. Interventional Cardiology in China. 2017;25: 61\u0026ndash;66. (In Chinese).\u003c/li\u003e\n \u003cli\u003eReisman, M., et al., \u003cem\u003eAnalysis of low-speed rotational atherectomy for the reduction of platelet aggregation.\u003c/em\u003e Cathet Cardiovasc Diagn, 1998. \u003cstrong\u003e45\u003c/strong\u003e(2): p. 208-14.\u003c/li\u003e\n \u003cli\u003eReisman, M., B.J. Shuman, and V. Harms, \u003cem\u003eAnalysis of heat generation during rotational atherectomy using different operational techniques.\u003c/em\u003e Cathet Cardiovasc Diagn, 1998. \u003cstrong\u003e44\u003c/strong\u003e(4): p. 453-5.\u003c/li\u003e\n \u003cli\u003eSakakura, K., et al., \u003cem\u003eThe incidence of slow flow after rotational atherectomy of calcified coronary arteries: A randomized study of low speed versus high speed.\u003c/em\u003e Catheter Cardiovasc Interv, 2017. \u003cstrong\u003e89\u003c/strong\u003e(5): p. 832-840.\u003c/li\u003e\n \u003cli\u003eYamamoto, T., et al., \u003cem\u003eA Novel Rotablator Technique (Low-Speed following High-Speed Rotational Atherectomy) Can Achieve Larger Lumen Gain: Evaluation Using Optimal Frequency Domain Imaging.\u003c/em\u003e J Interv Cardiol, 2019. \u003cstrong\u003e2019\u003c/strong\u003e: p. 9282876.\u003c/li\u003e\n \u003cli\u003eKobayashi N., et al., Additional debulking efficacy of low-speed rotational atherectomy after high-speed rotational atherectomy for calcified coronary lesion. Int J Cardiovasc Imaging. 2020;36(10):1811-1819.\u003c/li\u003e\n \u003cli\u003eWu, J., et al., \u003cem\u003eRotational Atherectomy in Coronary Heart Disease Patients with Different Rotational Speed: In Hospital and Six-Month Outcomes.\u003c/em\u003e RCM, 2023. \u003cstrong\u003e24\u003c/strong\u003e(1).\u003c/li\u003e\n \u003cli\u003eTomasiewicz B., et al., Acute Angulation and Sequential Lesion Increase the Risk of Rotational Atherectomy Failure. Circ J. 2021;85(6):867-876.\u003c/li\u003e\n \u003cli\u003eWhiteside HL., et al., Safety and efficacy of stent ablation with rotational atherectomy for the management of underexpanded and undilatable coronary stents. Cardiovasc Revasc Med. 2019;20(11):985\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eHachinohe D., et al., Treatment for in-stent restenosis requiring rotational atherectomy. J Interv Cardiol. 2018;31(6):747\u0026ndash;54.\u003c/li\u003e\n \u003cli\u003e\u0026Eacute;des IF., et al., Rotational atherectomy of undilatable coronary stents: stent ablation, a clinical perspective and recommendation. EuroIntervention. 2016;12(5):e632\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eYasumura K., et al., Rotational atherectomy for the management of undilatable in-stent restenosis with single or multiple stent layers. Cardiovasc Revasc Med. 2022;34:32\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eTokarek, T., et al., \u003cem\u003eRadial Approach Expertise and Clinical Outcomes of Percutanous Coronary Interventions Performed Using Femoral Approach.\u003c/em\u003e J Clin Med, 2019. \u003cstrong\u003e8\u003c/strong\u003e(9).\u003c/li\u003e\n \u003cli\u003eHe, Y., et al., \u003cem\u003eA Backing-Layer-Shared Miniature Dual-Frequency Ultrasound Probe for Intravascular Ultrasound Imaging: In Vitro and Ex Vivo Validations.\u003c/em\u003e Biosensors (Basel), 2023. \u003cstrong\u003e13\u003c/strong\u003e(11).\u003c/li\u003e\n \u003cli\u003eTearney, G.J., et al., \u003cem\u003eConsensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation.\u003c/em\u003e J Am Coll Cardiol, 2012. \u003cstrong\u003e59\u003c/strong\u003e(12): p. 1058-72.\u003c/li\u003e\n \u003cli\u003eCohen, J., \u003cem\u003eStatistical power analysis for the behavioral sciences\u003c/em\u003e. 2013: routledge.\u003c/li\u003e\n \u003cli\u003eG\u0026eacute;n\u0026eacute;reux, P., et al., \u003cem\u003eTwo-year outcomes after percutaneous coronary intervention of calcified lesions with drug-eluting stents.\u003c/em\u003e Int J Cardiol, 2017. \u003cstrong\u003e231\u003c/strong\u003e: p. 61-67.\u003c/li\u003e\n \u003cli\u003eMadhavan, M.V., et al., \u003cem\u003eCoronary artery calcification: pathogenesis and prognostic implications.\u003c/em\u003e J Am Coll Cardiol, 2014. \u003cstrong\u003e63\u003c/strong\u003e(17): p. 1703-14.\u003c/li\u003e\n \u003cli\u003eLee, M.S., et al., \u003cem\u003eImpact of coronary artery calcification in percutaneous coronary intervention with paclitaxel-eluting stents: Two-year clinical outcomes of paclitaxel-eluting stents in patients from the ARRIVE program.\u003c/em\u003e Catheter Cardiovasc Interv, 2016. \u003cstrong\u003e88\u003c/strong\u003e(6): p. 891-897.\u003c/li\u003e\n \u003cli\u003eG\u0026eacute;n\u0026eacute;reux, P., et al., \u003cem\u003eIschemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes. Pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS.\u003c/em\u003e J Am Coll Cardiol, 2014. \u003cstrong\u003e63\u003c/strong\u003e(18): p. 1845-54.\u003c/li\u003e\n \u003cli\u003eBourantas, C.V., et al., \u003cem\u003ePrognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials.\u003c/em\u003e Heart, 2014. \u003cstrong\u003e100\u003c/strong\u003e(15): p. 1158-64.\u003c/li\u003e\n \u003cli\u003eSafian RD., et al., Coronary angioplasty and Rotablator atherectomy trial (CARAT): immediate and late results of a prospective multicenter randomized trial. Catheter Cardiovasc Interv. 2001;53(2):213-220.\u003c/li\u003e\n \u003cli\u003eGupta, T., et al., \u003cem\u003eRotational Atherectomy: A Contemporary Appraisal.\u003c/em\u003e Interv Cardiol, 2019. \u003cstrong\u003e14\u003c/strong\u003e(3): p. 182-189.\u003cstrong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"trials","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"trls","sideBox":"Learn more about [Trials](http://trialsjournal.biomedcentral.com/)","snPcode":"13063","submissionUrl":"https://www.editorialmanager.com/trls","title":"Trials","twitterHandle":"MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"rotational atherectomy, high speed, low speed, vascular calcification","lastPublishedDoi":"10.21203/rs.3.rs-5129794/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5129794/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eThe increasing incidence of coronary heart disease, driven by socio-economic development and population aging, poses significant challenges. Coronary calcification, a major factor complicating percutaneous coronary interventions (PCI), often necessitates rotational atherectomy (RA) for lesion preparation. However, the impact of different RA rotational speeds on procedural and clinical outcomes remains unclear. While low-speed RA (LSRA) has been suggested to reduce intraoperative slow flow, evidence is inconsistent, and the benefits of combining LSRA with high-speed RA (HSRA) are not well established. This study aims to evaluate the effectiveness of different rotational speed protocols to guide clinical practice.\u003c/p\u003e\u003ch2\u003eMethods and analysis\u003c/h2\u003e \u003cp\u003eThis single-center, randomized controlled trial will target patients with severe coronary artery calcification scheduled for RA. An estimated 210 patients will be enrolled based on sample size calculation, randomly assigned in a 1:1:1 ratio to different rotational speed protocols using a random number table. These will include a continuous low-speed rotation (LSRA) group (140,000 rpm), a continuous high-speed rotation (HSRA) group (180,000 rpm), and a high-speed to low-speed rotation (HSRA\u0026thinsp;+\u0026thinsp;LSRA) group (initially 180,000 rpm, followed by 100,000 rpm). The primary endpoint is the incidence of complications during RA, including coronary artery spasm, slow/no reflow, dissection, burr entrapment, guidewire fracture, and perforation. Secondary outcomes encompass intravascular imaging (IVUS or OCT) assessments (detecting calcific ring disruption and measuring the target lesion's minimum lumen area (MLA) and minimum lumen diameter (MLD)); in-hospital cardiac death, acute stent thrombosis, and heart failure occurrences; and the one-year incidence of major adverse cardiovascular and cerebrovascular events (MACCE).\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003eThe RACE study evaluates the impact of different rotational speeds in coronary rotational atherectomy, aiming to provide guidance for clinical practice. The findings may help standardize RA procedures and inform future clinical guidelines, improving procedural consistency and patient outcomes.\u003c/p\u003e\u003ch2\u003eRegistration number\u003c/h2\u003e \u003cp\u003eChiCTR2300076194, Registered 27 September 2023.\u003c/p\u003e","manuscriptTitle":"Safety and Efficacy of Different Rotational Speed during Rotational Atherectomy in Coronary Heart Disease Patients (RACE): study protocol for a randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-26 09:02:47","doi":"10.21203/rs.3.rs-5129794/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accept","date":"2025-04-03T03:18:54+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2025-03-23T07:05:21+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-23T04:56:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-21T05:32:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"Trials","date":"2025-03-20T13:56:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"trials","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"trls","sideBox":"Learn more about [Trials](http://trialsjournal.biomedcentral.com/)","snPcode":"13063","submissionUrl":"https://www.editorialmanager.com/trls","title":"Trials","twitterHandle":"MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d76b6d4-7b39-40e8-aede-54d79745fc10","owner":[],"postedDate":"March 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-14T16:08:00+00:00","versionOfRecord":{"articleIdentity":"rs-5129794","link":"https://doi.org/10.1186/s13063-025-08834-6","journal":{"identity":"trials","isVorOnly":false,"title":"Trials"},"publishedOn":"2025-04-08 16:05:07","publishedOnDateReadable":"April 8th, 2025"},"versionCreatedAt":"2025-03-26 09:02:47","video":"","vorDoi":"10.1186/s13063-025-08834-6","vorDoiUrl":"https://doi.org/10.1186/s13063-025-08834-6","workflowStages":[]},"version":"v1","identity":"rs-5129794","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5129794","identity":"rs-5129794","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}