Safety and outcomes of upfront large-size rotational atherectomy burrs in left main coronary interventions

Objectives
Data on the safety and efficacy of percutaneous coronary intervention (PCI) with adjunctive rotational atherectomy (RA) in left main (LM) disease are limited. Current guidelines recommend using a small-size RA burr initially, with upsizing if required. The safety of upfront use of a large-size RA burr (≥1.75 mm) is unknown. The authors assessed the safety of an upfront large rotablation burr in the treatment of LM calcification and the procedural and long-term outcome of this approach in comparison to a small-size burr.
Methods
Retrospective analysis of all patients undergoing PCI with adjunctive RA to LM disease. The study outcomes were all-cause mortality and repeat target lesion revascularization (TLR) at medium-term follow-up in patients treated with large burr size (≥1.75mm) compared to small burr size (<1.75mm).
Results
Two hundred forty-three patients (mean age 75 ± 9 years, 80% males) were included. Approximately half of the patients were treated with a large-size RA burr (≥1.75 mm). Most treated lesions were bifurcation lesions involving the 3 branches (86%) with SYNTAX score of 35 ± 11. Radial access was used in two-thirds of patients; 7F sheath was the most used. There was no difference between the small and large burr groups in procedural complications (11% vs 8%, P = .512), all-cause mortality (34% vs 28%, P = .267), and repeat TLR up to 4 years after PCI (2.9% vs 2.1%, P = .473).
Conclusions
Upfront use of a large-size RA burr is feasible and safe for treating calcified LM disease, with no increase in procedural complications, repeat TLR, or medium-term all-cause mortality.