title: Rotational atherectomy followed by cutting-balloon plaque modification for drug-eluting stent implantation in calcified coronary lesions.
abstract: BACKGROUND
  Drug-eluting stent (DES) underexpansion has been reported as an independent factor for restenosis and thrombosis; therefore, adequate plaque modification prior to DES implantation is the key of calcified lesion treatment.
  
  
  METHODS
  Consecutive patients with severely calcified lesions undergoing rotational atherectomy (RA) followed by balloon dilatation before DES implantation were analyzed. Patients were divided into two groups based on the balloon type before stent implantation: the cutting balloon (ROTACUT group) and the plain balloon (control group).
  
  
  RESULTS
  Twenty-five patients with 26 calcified lesions were identified: 10 patients (10 lesions) were included in the ROTACUT group and 15 patients (16 lesions) in the control group. There were statistically no differences in the final burr size (1.65 ± 0.21 mm vs 1.67 ± 0.22 mm; P=.803), the maximum (max) balloon diameter before stent implantation (2.85 ± 0.34 mm vs 2.72 ± 0.42 mm; P=.411), the max final balloon diameter (3.30 ± 0.33 mm vs 3.28 ± 0.44 mm; P=.908), and the max final balloon inflation pressure (15.3 ± 3.0 atm vs 16.4 ± 5.5 atm; P=.501). Final minimum stent cross-sectional area (CSA) was significantly larger in the ROTACUT group compared to the control group (6.80 ± 1.27 mm² vs 5.38 ± 1.89 mm²; P=.048).
  
  
  CONCLUSIONS
  RA followed by cutting balloon plaque modification for DES implantation in severely calcified lesions appears to be more efficacious including significantly larger final stent CSA.
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan. shinichi.furuichi@gmail.com
authors.forename: Shinichi
authors.initials: S
authors.lastname: Furuichi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tobaru
authors.forename: Ryuta
authors.initials: R
authors.lastname: Asano
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Itaru
authors.initials: I
authors.lastname: Takamisawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.forename: Hitonobu
authors.initials: H
authors.lastname: Tomoike
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017225:Atherectomy, Coronary / Q000379:methods; D015897:Comorbidity; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000453:epidemiology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000628:therapy*; D018084:Ultrasonography, Interventional