Clinical Outcomes Following Atherectomy of Calcified Left Main Coronary

Introduction: Plaque modifying-debulking devices are the most effective initial strategy for percutaneous coronary intervention of severely calcified lesions including left main coronary artery. There are limited data comparing the short- and long-term clinical outcomes of these devices in left main lesions.

Methods: A retrospective analysis of patients with calcified left main lesions treated with percutaneous intervention with adjunctive plaque modifying device at a large tertiary center between 2008 and 2021. The primary endpoint was long-term mortality at documented longest follow-up. Secondary endpoints included procedural complications and in-hospital clinical outcome.

Results: A total of 302 patients with calcified left main lesions treated with rotational atherectomy (RA) (n = 240), intracoronary lithotripsy (n = 30), or excimer laser coronary atherectomy (n = 32) were included. Out of all patients, 55% presented with acute coronary syndromes. Technical success was achieved in 98.7% of the patients and procedural success was achieved in 95.4% of the patients. At a median follow-up of 42 (19–62) months, there was no difference in mortality between the 3 devices (RA 54/240 [23.4%] vs. lithotripsy 1/30 [3.3%] vs. laser 5/32 [15.6%], p = 0.128). Likewise, in-hospital clinical outcomes were similar. However, procedural complications were higher in the laser group.

Conclusions: In patients with calcified left main lesions treated with percutaneous intervention, adjunctive plaque-modifying devices appear safe with survival exceeding 80% at long-term follow-up with no difference between the devices in relation to in-hospital clinical outcomes or long-term mortality risk.