Background

Severe coronary artery calcification remains one of the most significant challenges in percutaneous coronary intervention (PCI). Calcified lesions are associated with lower procedural success rates, inadequate stent expansion, increased restenosis, and adverse cardiovascular outcomes. Rotational atherectomy (RA) has emerged as an important plaque-modification strategy that facilitates successful stent delivery and expansion in heavily calcified coronary lesions.

Objective

To evaluate procedural success, clinical outcomes, complications, and contemporary applications of rotational atherectomy in patients undergoing PCI for heavily calcified coronary artery disease.

Methods

A retrospective observational study was conducted involving 320 patients with severely calcified coronary lesions treated using rotational atherectomy prior to drug-eluting stent implantation between January 2020 and December 2024. Clinical characteristics, procedural parameters, angiographic outcomes, and major adverse cardiovascular events (MACE) were analyzed over a 12-month follow-up period.

Results

Procedural success was achieved in 95.3% of patients. Mean lesion length was 28.4 ± 11.6 mm, and average burr size was 1.59 ± 0.21 mm. Drug-eluting stents were successfully implanted in 98.1% of cases. In-hospital MACE occurred in 3.4% of patients. At 12 months, target lesion revascularization was observed in 5.6%, myocardial infarction in 3.8%, and cardiac death in 2.5% of patients. Imaging-guided PCI significantly improved stent expansion and reduced adverse outcomes.

Conclusion

Rotational atherectomy remains a safe and effective strategy for managing heavily calcified coronary lesions. Integration with intravascular imaging and contemporary PCI techniques provides excellent procedural success and favorable long-term outcomes.