Considering optimal strategy in rotational atherectomy

Clinical outcomes of percutaneous coronary intervention (PCI) have been improving due to evolutions such as development of new-generation drug-eluting stents, use of intracoronary imaging device and widespread use of optimal medical therapy 1 .Nevertheless, current PCI has not achieved outcomes comparable to coronary artery bypass grafting (CABG) 2-3 , especially in patients with complex lesions such as heavily calcified lesions.Rotational atherectomy (RA) is one of the important options for heavily calcified lesions in PCI.However, the clinical adverse event rate in PCI requiring RA has been high in real-world practice 4 .To improve clinical outcomes of PCI requiring RA, some important procedural points should be addressed.First, avoiding life-threatening complications such as coronary perforation should be the bottom-line requirement for the appropriate practice.Second, procedural management for preventing large periprocedural myocardial injury would be essential.Previous reports have suggested that large periprocedural myocardial infarctions were associated with a substantial increase in subsequent mortality 5 .Third, adequate ablation for optimal stent expansion is important.