title: Percutaneous Coronary Intervention in Severely Calcified Unprotected Left Main Coronary Artery Disease: Initial Experience With Orbital Atherectomy.
abstract: OBJECTIVE
  We report the clinical outcomes of patients who underwent percutaneous coronary intervention (PCI) with orbital atherectomy for severely calcified unprotected left main coronary artery (ULMCA) disease.
  
  
  BACKGROUND
  Although surgical revascularization is the gold standard for patients with ULMCA disease, not all patients are candidates for this. PCI is increasingly used to treat complex coronary artery disease, including ULMCA disease. The presence of severely calcified lesions increases the complexity of PCI. Orbital atherectomy can be used to facilitate stent delivery and expansion in severely calcified lesions. The clinical outcomes of patients treated with orbital atherectomy for severely calcified ULMCA disease have not been reported.
  
  
  METHODS
  From May 2014 to July 2015, a total of 14 patients who underwent PCI with orbital atherectomy for ULMCA disease were retrospectively evaluated. The primary endpoint was major cardiac and cerebrovascular event (cardiac death, myocardial infarction, stroke, and target-lesion revascularization) at 30 days.
  
  
  RESULTS
  The mean age was 78.2 ± 5.8 years. The mean ejection fraction was 41.8 ± 19.8%. Distal bifurcation disease was present in 9 of 14 patients. Procedural success was achieved in all 14 patients. The 30-day major adverse cardiac and cerebrovascular event rate was 0%. One patient had coronary dissection that was successfully treated with stenting. No patient had perforation, slow flow, or thrombosis.
  
  
  CONCLUSIONS
  Orbital atherectomy in patients with severely calcified ULMCA disease is feasible, even in high-risk patients who were considered poor surgical candidates. Randomized trials are needed to determine the role of orbital atherectomy in ULMCA disease.
authors.affiliation: Division of Interventional Cardiology, UCLA Medical Center, Los Angeles, CA 90095 USA. mslee@mednet.ucla.edu.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.forename: Evan
authors.initials: E
authors.lastname: Shlofmitz
authors.forename: Barry
authors.initials: B
authors.lastname: Kaplan
authors.forename: Richard
authors.initials: R
authors.lastname: Shlofmitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017073:Atherectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017225:Atherectomy, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011183:Postoperative Complications / Q000145:classification / Q000175:diagnosis / Q000517:prevention & control; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States; D061205:Vascular Calcification / Q000175:diagnosis / Q000503:physiopathology