title: High-speed rotational atherectomy of the left main coronary artery: a single-center experience in 50 high-risk patients.
abstract: BACKGROUND
  Certain patients with complex calcified left main (LM) disease have a prohibitive risk for bypass surgery. Rotational atherectomy (RA) prior to stent implantation is an option for this subset of patients.
  
  
  OBJECTIVE
  To analyze acute and long-term results of RA in the LM location.
  
  
  METHODS
  We present a single-center analysis of RA in severe LM disease applied in patients with high surgical risk.
  
  
  RESULTS
  RA was performed in the LM location in 50 consecutive patients with a mean age of 73years. In 30% of the patients clinical presentation was an acute coronary syndrome, and 42% had diabetes. LM bifurcation was involved in 80% of the cases, 36% had a Medina class 1.1.1 lesion, and 38% of RA procedures were performed as bailout. In 38% of patients the left main was protected. Median logistic EuroSCORE was 12.4% (interquartile range, IQR, 5.24-36.11%) and mean SYNTAX Score was 28.6±8.2. The median burr size was 1.5mm and a two-stent strategy was required in 58% of interventions. Drug-eluting stents were implanted in 86% of procedures. Angiographic success rate was 96%, and in-hospital major adverse cardiac event rate was 10%. Survival free of cardiac death at 12 and 24months was 87.6% and 78.4%. Target lesion revascularization rates (TLR) were 13.3% and 18.8%, respectively. Cardiac deaths were significantly higher in patients with acute coronary syndromes compared with patients with stable angina (cardiac death free survival was 72.7% and 94% at 12months, p=0.01). The TLR rate was numerically higher in diabetic patients (21.1% vs. 7.7% at one year, p=0.18).
  
  
  CONCLUSIONS
  Acute and long-term outcomes after LM rotational atherectomy are satisfactory, considering the high procedure- and patient-related risks.
authors.affiliation: Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Bad Segeberg, Germany. Electronic address: dmitriy.sulimov@segebergerkliniken.de.
authors.forename: Dmitriy S
authors.initials: DS
authors.lastname: Sulimov
authors.affiliation: Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Bad Segeberg, Germany.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Wahab
authors.affiliation: Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Bad Segeberg, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Toelg
authors.affiliation: Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Bad Segeberg, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Kassner
authors.affiliation: Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Bad Segeberg, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Geist
authors.affiliation: Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Bad Segeberg, Germany.
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017225:Atherectomy, Coronary / Q000379:methods; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D012306:Risk; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: Atherectomy; Complex lesions; Drug-eluting stent; Left main disease