title: Rotational atherectomy for left main coronary artery disease in octogenarians: transradial approach in a tertiary center and literature review.
abstract: OBJECTIVE
  The aim of this study was to appreciate the safety and effectiveness of transradial percutaneous coronary intervention (PCI) with rotational atherectomy for highly calcified left main coronary artery (LMCA) disease in octogenarians.
  
  
  BACKGROUND
  Conventional surgery is still considered the preferred management for LMCA disease; but, when the lesion is severely calcified, and the patient is unsuitable for surgery, the interventional cardiologist faces a complex PCI traditionally approached by femoral access.
  
  
  METHODS
  Between June 2004 and December 2010, octogenarians with calcified LMCA disease who were primary denied for surgical revascularization were enrolled. Procedural success and major adverse cerebral and cardiovascular events (MACCE) including death, nonfatal myocardial infarction, target lesion revascularization (TLR), or stroke during long-term follow-up were evaluated.
  
  
  RESULTS
  Forty-two consecutive patients ≥80 years had undergone stenting for calcified LMCA disease (13 with rotational atherectomy, the "Rota" group, and 29 without rotational atherectomy, the "without Rota" group). Procedural success was good (92.3% vs. 96.6%, respectively, p = NS). Mean follow-up time was 25.7 ± 21.4 and 28 ± 32.3 months, respectively. There was a TLR in 25% and 11.1%, respectively; p = NS. No difference was detected in terms of overall in-hospital or long-term mortality or MACCE.
  
  
  CONCLUSIONS
  Rotational atherectomy followed by stent implantation by transradial approach, when applied to heavily calcified lesions, appeared to be a safe and effective strategy for the treatment of LMCA disease in octogenarians who were refused for surgery.
authors.affiliation: CHU de Caen, Department of Interventional Cardiology, Caen, France. ziad_dahdouh@hotmail.com
authors.forename: Ziad
authors.initials: Z
authors.lastname: Dahdouh
authors.forename: Vincent
authors.initials: V
authors.lastname: Roule
authors.forename: Audrey Emmanuelle
authors.initials: AE
authors.lastname: Dugué
authors.forename: Rémi
authors.initials: R
authors.lastname: Sabatier
authors.forename: Thérèse
authors.initials: T
authors.lastname: Lognoné
authors.forename: Gilles
authors.initials: G
authors.lastname: Grollier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017225:Atherectomy, Coronary / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D017534:Radial Artery / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000601:surgery*