title: Rotablation in the treatment of high-risk patients with heavily calcified left-main coronary lesions.
abstract: OBJECTIVE
  Heavily calcified left-main coronary diseases (LMCA) remain a formidable challenge for percutaneous interventions (PCI). This study was to investigate the safety and efficacy of using rotational atherectomy (RA) in treating such lesions in actual practice.
  
  
  METHODS
  From February 2004 to March 2012, all consecutive patients who received RA for heavily-calcified LMCA lesions in our cath lab were enrolled. The relevant clinical and angiographic characteristics at the time of index PCI, as well as the clinical follow-up outcomes, were retrieved and analyzed.
  
  
  RESULTS
  A total of 34 consecutive patients were recruited with a mean age 77.2 ± 10.2 years. There were 82.4% presented with acute coronary syndrome and 11.8% with cardiogenic shock. Chronic renal disease and diabetes were seen in 64.7% and 52.9%, respectively. Triple-vessel coronary disease was found in 76.5% of them. The mean SYNTAX score was 50 ± 15 and EuroSCORE II scale 5.6 ± 4.8. The angiographic success rate was 100% with a procedural success rate of 91.2%. The mean number of burrs per patient was 1.7 ± 0.5. Crossing-over stenting was used in 64.7%. Most stents were drug-eluting (67.6%). Intra-aortic ballon pump was used in 20.6% of the procedures. Three patients died during hospitalization, all due to presenting cardiogenic shock. No major complication occurred. Among 31 hospital survivors, the major adverse cardiac events (MACE) rate was 16.1%, all due to target lesion revascularization or target vessel revascularization.
  
  
  CONCLUSIONS
  In high-surgical-risk elderly patients, plaque modification with RA in PCI of heavily-calcified LMCA could be safely accomplished with a minimal complication rate and low out-of-hospital MACE.
authors.affiliation: Division of Cardiology, Saint Mary's Hospital, 160 Zhongzheng South Road, Luodong, Yilan 26546, Taiwan, China.
authors.forename: Meng-Hsiu
authors.initials: MH
authors.lastname: Chiang
authors.forename: Hung-Tao
authors.initials: HT
authors.lastname: Yi
authors.forename: Cheng-Rong
authors.initials: CR
authors.lastname: Tsao
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Chang
authors.forename: Chieh-Shou
authors.initials: CS
authors.lastname: Su
authors.forename: Tsun-Jui
authors.initials: TJ
authors.lastname: Liu
authors.forename: Kae-Woei
authors.initials: KW
authors.lastname: Liang
authors.forename: Chih-Tai
authors.initials: CT
authors.lastname: Ting
authors.forename: Wen-Lieng
authors.initials: WL
authors.lastname: Lee
keywords: Heavily calcified; Left main coronary; Rotational atherectomy