Clinical outcomes following debulking atherectomy of calcified left main coronary lesions: a high-volume centre experience

Abstract Introduction Plaque modifying-debulking (PMD) devices are the most effective initial strategy for percutaneous coronary intervention (PCI) of severely calcified lesions including left main coronary artery (LMCA). There is limited data comparing the short and long clinical outcomes of these devices in LMCA lesions. Methods A retrospective analysis of patients with fibrocalcified LMCA lesions treated with PCI with adjunctive PMD devices at a large centre between 2008 and 2021. The primary study endpoint was long-term mortality at documented longest follow-up. Secondary endpoints included procedural complications and inhospital clinical outcome. Results A total of 302 patients with fibrocalcified LMCA lesions treated with rotational atherectomy (RA; n=240), intracoronary lithotripsy (ICL; n=30) or excimer laser coronary atherectomy (ELCA; n=32) were included. Approximately 55% of all patients presented with acute coronary syndromes. Technical success was achieved in 98.7% of patients and procedural success was achieved in 95.4% of patients. At a median follow-up of 42 [19-62] months, there was no difference in mortality between the 3 PMD modalities (RA 54/240 [23.4%] vs. ICL 1/30 [3.3%] vs. ELCA 5/32 [15.6%], P=0.128). Likewise, in-hospital clinical outcomes were similar. However, procedural complications were significantly higher in the ELCA group. Conclusions In patients with fibrocalcified LMCA lesions treated with PCI, adjunctive PMD devices appear safe with survival excceding 80% at long-term follow-up. Our study suggests that ELCA use may be associated with higher procedural risks however this did not increase in-hospital clinical outcomes or long-term mortality risk.