title: Rotational Atherectomy and Stent Implantation for Calcified Left Main Lesions.
abstract: BACKGROUND
  Left main coronary artery (LMCA) bifurcation and heavily calcified lesions are common and challenging to treat percutaneously. Rotational atherectomy (RA) may be beneficial in this setting to facilitate stent placement though direct supporting evidence is lacking. This study sought to analyze patients who underwent RA of the LMCA.
  
  
  METHODS
  Consecutive cases involving RA of the LMCA between 1/1/2004 and 12/31/2009 at a private, tertiary referral hospital were reviewed retrospectively. Medical records, angiograms and clinically driven follow-up were reviewed.
  
  
  RESULTS
  Thirty-one cases were identified (20 protected, 11 unprotected), including 23 with stent implantation (21 drug-eluting, 2 bare metal). All 31 lesions had moderate to severe calcification, 84% involved the distal segment. Mean burr-to-vessel ratio was 0.43. Overall angiographic success was 90% (28/31) and was higher with a drug-eluting stent versus no stent (100% vs. 62%; P = 0.0153). In-hospital major adverse cardiovascular events (MACE) occurred in 1 patient (3%). Mid-term MACE occurred in 6 patients (26%) and tended to occur less frequently in patients with protected LMCAs (P = 0.0697). At final follow-up, patients were more likely to be alive and free from angina with a protected LMCA (94% vs. 57% unprotected; P = 0.0564) and with a drug-eluting stent (89% vs. 50% with no stent; P = 0.0281).
  
  
  CONCLUSIONS
  RA of the LMCA to facilitate stent implantation appears to be safe and effective with favorable mid-term outcomes. In the setting of severe calcification and distal LMCA involvement RA and drug-eluting stent implantation should be considered.
authors.affiliation: Heart Institute, Good Samaritan Hospital, Los Angeles, California, USA.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Schwartz
authors.affiliation: Department of Cardiology, Good Samaritan Hospital, Los Angeles, California, USA.
authors.forename: Guy S
authors.initials: GS
authors.lastname: Mayeda
authors.affiliation: Department of Cardiology, Good Samaritan Hospital, Los Angeles, California, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Economides
authors.affiliation: Heart Institute, Good Samaritan Hospital, Los Angeles, California, USA; Department of Internal Medicine, Division of Cardiovascular Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kloner
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Shavelle
authors.affiliation: Department of Cardiology, Good Samaritan Hospital, Los Angeles, California, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Burstein
keywords: Cardiac catheterization; Devices; Drug-eluting stent