High-speed rotational atherectomy of the left main coronary artery: a single-center experience in 50 high-risk patients

•Single-center analysis of 50 patients not eligible for cardiac surgery.•Survival free of cardiac death at 12 and 24 months was 87.5% and 78.3%.•Cardiac deaths were significantly higher in patients with acute coronary syndromes.•Acute and long-term outcomes are promising.

BackgroundCertain 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.ObjectiveTo analyze acute and long-term results of RA in the LM location.MethodsWe present a single-center analysis of RA in severe LM disease applied in patients with high surgical risk.ResultsRA was performed in the LM location in 50 consecutive patients with a mean age of 73 years. 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 1.5 mm 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 24 months 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 12 months, p = 0.01). The TLR rate was numerically higher in diabetic patients (21.1% vs. 7.7% at one year, p = 0.18).ConclusionAcute and long-term outcomes after LM rotational atherectomy are satisfactory, considering the high procedure- and patient-related risks.