Percutaneous coronary interventions (PCI) for severely calcified lesions is associated with higher complications rate. Rotational atherectomy (RA) has become increasingly utilized in PCI for managing heavily calcified coronary lesions. The aim of this study is to describe the in-hospital and 30 days outcomes of PCI facilitated by RA in a University Hospital

Methods and Results: We analyzed medical records of patients undergoing PCI with RA for coronary lesions from 2022 and 2023. Procedures were performed with the Rotablator™ rotational atherectomy system (Boston Scientific, MA, USA). Primary outcomes included procedural success, and in-hospital complications. Data are reported as mean and standard deviation or number and percentage (%)

Rotational atherectomy was done in 2% of the PCI between December 2021 and February 2024. During the study period, 18 patients with 22 de novo calcified coronary lesions were treated with RA. The mean age was 72 ± 12 years-old and 8 (44%) of the patients were women. Eight (44%) of the patients were diabetic, 5 (28%) had history of chronic kidney disease, 4 (22%) of the patients had a previous CABG and 9 (50%) a PCI. Severe LVEF was observed in 3 (17%) of cases. Thirteen (72%) of the cases were done due to NSTEMI

Complex lesions such as bifurcations, tortuosity and CTO compromised 12 (54%), 7 (31%) y 2 (9%) of the lesions, respectively. The left anterior descending artery was the main target vessel (N:16 - 55%). Rotational atherectomy of the left main was done in 4 (18%) of the lesions. Twenty-one (95%) of the RA were performed as a planned procedure. In 4 (18%) of the cases RA was done after a balloon angioplasty failure

Trans radial approach was used in 10 (45%) of cases. The most frequent sheath was 7 French (N:16 - 73%). The most frequently used burr was 1.25 mm (N:18 -81%) and 6 (27%) of the lesions needed an upgrade in the burr size. Operators performed a mean of 2.54 ± 1.22 burr runs during the procedure. Cutting balloon was used as a plaque modifying technique after RA in 2 lesions.

Drug-eluting stents were used in 21 (95%) of lesions, except of one lesion that could not be successfully modified despite the use of non-compliant balloon and cutting balloon. The mean number of stents implanted was 1,5 ± 1 stents. The mean length was 46,2 ± 24,5 mm and the mean diameter was 3.05 ± 0.47 mm. Intravascular imaging was used to optimize DES implantation in 8 (36%) of cases, and all left main PCI procedures were done with IVUS

Final TIMI 3 flow was achieved in all treated lesions. Coronary perforation occurred in one patient after DES implantation, resolved with prolonged balloon inflation. Coronary artery dissection was observed in 1 small size side branch after RA. There were no cases of burr entrapment and no complications related to the vascular access

The mean hospital stay was 3 ± 3 days. The incidence of cardiovascular mortality at 30 days was 5%, and heart failure rehospitalization at 30 days was 16%.