Intravascular Ultrasound-Guided Planned Rotational Atherectomy for Grade Ⅲ Coronary Calcified Stenose Versus Cutting Balloon: A Single-Center Prospective Study

Planned rotational atherectomy (RA) has been widely used for severely calcified lesions, but moderate to severe coronary calcified lesions (CCL) are recommended for bailout RA. In this study, we sought to clarify whether intravascular ultrasound (IVUS)-guided planned RA is superior to cutting balloons (CB) for moderate to severe CCL. Patients with grade Ⅲ CCL were randomly assigned to percutaneous coronary intervention with RA or CB. The primary endpoint was strategy success and the coprimary endpoint was stent expansion. Secondary endpoints included procedural expense and duration, contrast amount, stent thrombosis, and major adverse cardiac events (MACE) at 30 days. A total of 80 patients (65.4 ± 8.0 vs 62.4 ± 11.2 years, p = 0.144) were enrolled, 40 in each group. Prior myocardial infarction was present in 2 (5%) versus 8 (20%) patients, p = 0.043. Strategy success rate was higher with planned RA compared with CB (95% vs 80%, p = 0.043). Stent expansion indices (stent expansion rate >80%, minimal stent area >5.0 mm², and stent asymmetry) were significantly better in the RA group (p <0.05). X-ray dose, contrast amount, and procedural expense were higher in the RA group (p <0.05), but no significant differences in procedural duration or 30-day MACE were observed between groups (p >0.05). In conclusion, IVUS-guided planned RA for grade Ⅲ CCL results in higher strategy success and better stent expansion than CB, with rare procedural complications and few clinical adverse events at 30 days, providing novel insight into pretreatment of moderate to severe CCL.