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Severe coronary calcifications are an independent factor of poor prognosis. They are associated with high rates of short- and long-term complications. The main objective of our study was to report our experience in the use of rotational atherectomy (RA) in the treatment of calcified lesions in different sitting and to describe the intra-hospital results evaluating the safety of this technique in real life. We enrolled all consecutive patients with calcified coronary lesions who underwent RA between January 2018 and March 2020. Clinical, angiographic characteristic and in hospital results data were collected to evaluate the results and the safety of this technique in a real-life experience including bifurcation and left main lesions. A total of 96 patients with 116 coronary lesions were included in our study. RA procedures represent 1.78% of total percutaneous coronary interventions (PCI). The mean age was 75.6 ± 8.2 years, all patients had at least one cardiovascular risk factor. Angiographic characteristics analysis revealed that the left anterior descending artery (LAD) was the most treated artery (50.9%) and 78.1% of patients had multivessel disease. RA was performed in bifurcation lesions in 20.7% of cases and in the left main stenosis in 13.6% of cases. Half of our patients had a Syntax score I > 22. The most used burr was 1.5 mm (56.9%). The burr-to-artery ratio was 0.5 with an IQR of (0.42–0.56). Procedural success was obtained in 97.4% of cases. Regarding complications we noted 3 (2.6%) cases of slow flow/no reflow, 4 (3.4%) cases of coronary dissection, 1 stuck burr and no case of coronary perforation. RA in left main and bifurcations were not associated with an excess of complications compared with other lesions. RA is an effective tool and safe technique with a low rate of complications to treat challenging calcified coronary lesions even in left main and bifurcation lesions. [ABSTRACT FROM AUTHOR]

The challenges of coronary bifurcation angioplasty are linked to the fractal geometry of their anatomy, responsible for the differences in diameter between the different segments with risk of stent malposition in the main branch and difficulty to access the side branch. Dedicated stents for bifurcation have been developed to reduce these potential risks. The BiOSS ® LIM C stent (Balton, Warsaw, Poland) is a Cobalt Chrome drug eluting stent with Sirolimus dedicated to the treatment of bifurcation lesions. Our single-center retrospective study included 173 consecutive patients treated for a bifurcation lesion with a BiOSS ® LIM C stent between December 2017 and February 2020. The mean age was 71 ± 11.6 years. The percentage of true bifurcation lesions was 27.2%. The angioplasty success rates for the main branch and the side branch were respectively 100% and 99.4%. The mean duration of follow-up was 311 days. We observed during the follow-up: 4 cardiovascular deaths (2.3%), 5 myocardial infarctions (2.9%), 2 stent thrombosis (1.2%), 10 TLR (6%), 16 TVR (9.2%), 18 TVF (10.4%). The probabilities of overall survival, survival without cardiovascular death or myocardial infarction and survival without TVF are respectively 95%, 90% and 81%. Angioplasty of coronary bifurcation lesions with a dedicated stent BiOSS ® LIM C is safe and provides very good immediate and long-term results. [ABSTRACT FROM AUTHOR]