title: Impact of rotational atherectomy on heavily calcified, unprotected left main disease.
abstract: BACKGROUND
  There is little data on percutaneous coronary intervention (PCI) using rotational atherectomy (Rota) for severely calcified unprotected left main (ULM) lesions.
  
  
  RESULTS
  Between January 2005 and August 2011, 64 consecutive patients who underwent drug-eluting stent implantation using Rota were retrospectively evaluated. Of these, 54.7% and 20.3% patients had diabetes and were undergoing hemodialysis (HD), respectively. The mean EuroSCORE and SYNTAX score was 5.6 and 35.4, respectively. Procedural success, defined as residual stenosis <30%, was achieved in 95.3% of patients without fatal complications. Periprocedural myocardial infarction occurred in 7.8% patients. At the 1-year follow up, cardiac death was observed in 6.3% of patients, and target lesion revascularization (TLR) and TLR in the main branch (TLR-MB) were required in 18.8% and 10.9% patients, respectively. Optimal stent expansion was achieved in the majority of 33 patients with available intravascular ultrasound (IVUS) data. However, 5 of 9 HD patients who underwent IVUS required TLR-MB despite optimal stent expansion. The rate of TLR-MB was significantly lower in the non-HD patients than in the HD patients (2.1% vs. 46.2%; P=0.003).
  
  
  CONCLUSIONS
  PCI using Rota for calcified ULM lesions might guarantee high procedural success and a low complication rate. Although acceptable results were obtained at the 1-year follow up for non-HD patients, the rate of TLR-MB was considerably high for HD patients despite optimal stent expansion.
authors.affiliation: Department of Cardiology, Interventional Cardiology Unit, New Tokyo Hospital.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Yabushita
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.forename: Satoko
authors.initials: S
authors.lastname: Tahara
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujino
authors.forename: Takayuki
authors.initials: T
authors.lastname: Warisawa
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Kawamoto
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Satoru
authors.initials: S
authors.lastname: Mitomo
authors.forename: Kenichi
authors.initials: K
authors.lastname: Karube
authors.forename: Takahiro
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Sato
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Hisaaki
authors.initials: H
authors.lastname: Ishiguro
authors.forename: Keiko
authors.initials: K
authors.lastname: Fukino
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kurita
authors.forename: Shotarou
authors.initials: S
authors.lastname: Nakamura
authors.forename: Koji
authors.initials: K
authors.lastname: Hozawa
authors.forename: Sunao
authors.initials: S
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017225:Atherectomy, Coronary / Q000379:methods*; D054855:Drug-Eluting Stents; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000601:surgery*; D014463:Ultrasonography; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000601:surgery*