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.

Keywords: calcium; coronary artery disease; percutaneous coronary intervention; rotational atherectomy.