title: Percutaneous coronary intervention with rotational atherectomy for severely calcified unprotected left main: immediate and two-years follow-up results.
abstract: BACKGROUND
  According to current practice guidelines, coronary bypass surgery is the standard care option for unprotected left main (ULM) stenosis. However, a group of high surgical risk patients who are not eligible for coronary bypass surgery could benefit from percutaneous coronary intervention (PCI). Severe calcification hampers PCI in this setting, and rotational atherectomy (RA) could be of great help.
  
  
  METHODS
  We retrospectively analyzed a cohort of 40 patients with severely calcified ULM stenosis, not eligible for coronary artery bypass grafting, who underwent RA in our center.
  
  
  RESULTS
  Forty patients (mean age, 73 ± 8 years; 26 males) with ULM stenosis were treated with RA. Twenty-seven (67%) had distal stenosis. The mean number of treated vessels was 2.38 ± 0.74, with a mean lesion length of 30 ± 18 mm. Abciximab was used in 12 (30%) cases and an intra-aortic balloon pump in three cases. One patient died during the procedure and another two patients died in the first 24 hr after the procedure. The major events registered after the procedure included one significant branch loss, and two minor and one major case of bleeding (the latter requiring transfusion) at the puncture point. After a median of 24.7 (IQR 19.6-34.3) months of follow-up, 12 cardiac deaths were recorded. Survival free of cardiac death was 71 ± 7% and clinical guided target vessel revascularization 19.3 ± 7% at 2 years.
  
  
  CONCLUSIONS
  In a group of high surgical risk patients, RA on severely calcified left main stenosis is feasible and, in spite of high mortality rates, could pose the only possible effective treatment.
authors: Department of Cardiology, Virgen de la Arrixaca University Hospital, Murcia, Spain. jgarciadelara@gmail.com
authors: Juan
authors: J
authors: Garcia-Lara
authors: Eduardo
authors: E
authors: Pinar
authors: Raul
authors: R
authors: Valdesuso
authors: Javier
authors: J
authors: Lacunza
authors: Juan R
authors: JR
authors: Gimeno
authors: José A
authors: JA
authors: Hurtado
authors: Mariano
authors: M
authors: Valdés-Chávarri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017225:Atherectomy, Coronary / Q000009:adverse effects / Q000401:mortality; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*
chemical_list: D010975:Platelet Aggregation Inhibitors