Bioadaptor Implantation in Complex Calcified Coronary Lesions

BACKGROUND: Calcified coronary lesions remain among the most challenging subsets in percutaneous coronary intervention (PCI) because of their morphological complexity. Restoring physiological vasomotion and vascular remodeling is an emerging goal in PCI. CASE SUMMARY: We present 3 patients with severely calcified coronary lesions treated with PCI. Lesion preparation included rotational atherectomy was performed in 2 of 3 cases, followed by implantation of a bioadaptor-a sirolimus-eluting cobalt-chromium hybrid stent system. In 1 case, a super high-pressure OPN balloon was used for postdilatation. Six-month follow-up angiography showed favorable outcomes with sustained vessel patency in all cases. DISCUSSION: This is the first case series reporting bioadaptor use in heavily calcified coronary lesions. Adequate lesion preparation is essential for procedural success and clinical outcomes. TAKE-HOME MESSAGES: In this case series, bioadaptor implantation in severely calcified coronary lesions was feasible, with favorable short-term outcomes at 6 months. In calcified lesions, more aggressive lesion preparation than for conventional drug-eluting stents may be required, as adequate calcium modification is a prerequisite for full device expansion and for realizing the bioadaptor's long-term functional benefits after uncaging.