Rotational atherectomy: In hospital results of a real life experience for the treatment of complex calcified coronary lesions

Abstract

Severe coronary calcifications are an independent factor of poor prognosis. They are associated with high rates of short- and long-term complications. The main objective of our study was to report our experience in the use of rotational atherectomy (RA) in the treatment of calcified lesions in different sitting and to describe the intra-hospital results evaluating the safety of this technique in real life. We enrolled all consecutive patients with calcified coronary lesions who underwent RA between January 2018 and March 2020. Clinical, angiographic characteristic and in hospital results data were collected to evaluate the results and the safety of this technique in a real-life experience including bifurcation and left main lesions. A total of 96 patients with 116 coronary lesions were included in our study. RA procedures represent 1.78% of total percutaneous coronary interventions (PCI). The mean age was 75.6 ± 8.2 years, all patients had at least one cardiovascular risk factor. Angiographic characteristics analysis revealed that the left anterior descending artery (LAD) was the most treated artery (50.9%) and 78.1% of patients had multivessel disease. RA was performed in bifurcation lesions in 20.7% of cases and in the left main stenosis in 13.6% of cases. Half of our patients had a Syntax score I > 22. The most used burr was 1.5 mm (56.9%). The burr-to-artery ratio was 0.5 with an IQR of (0.42–0.56). Procedural success was obtained in 97.4% of cases. Regarding complications we noted 3 (2.6%) cases of slow flow/no reflow, 4 (3.4%) cases of coronary dissection, 1 stuck burr and no case of coronary perforation. RA in left main and bifurcations were not associated with an excess of complications compared with other lesions. RA is an effective tool and safe technique with a low rate of complications to treat challenging calcified coronary lesions even in left main and bifurcation lesions.