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.