Comparison of rotational atherectomy and modified balloons for calcified lesion preparation: a single-centre experience

AIM: To compare the efficacy and safety of rotational atherectomy (RA) and modified balloons (MB) for calcified coronary lesion preparation. METHODS: This retrospective, single-centre study included 92 consecutive patients with angiographically significant coronary artery calcification (CAC) treated between September 2021 and December 2024. Patients were stratified according to lesion-preparation strategy: RA with the RotaPro system (Boston Scientific, Marlborough, MA, USA) (n = 42) or MB, including scoring or cutting balloons (n = 50). Patients treated with intravascular lithotripsy, super-high-pressure balloons, or non-compliant balloons alone were excluded. The primary endpoint was 1-year cardiovascular mortality, and the secondary endpoint was procedural success, defined as successful stent or drug-coated balloon implantation with <10% residual stenosis and final Thrombolysis in Myocardial Infarction grade 3 flow. RESULTS: Baseline age and renal function were comparable between groups. Microcatheter use was more frequent in the RA group (p<0.001), whereas smoking was more prevalent in the MB group (p=0.043). Fluoroscopy time was longer in the RA group (p<0.001). Cardiovascular mortality and procedural success did not differ significantly between groups. CONCLUSION: In this real-world single-centre experience, RA and MB showed comparable feasibility and one-year clinical outcomes for the treatment of CAC. A lesion-specific approach integrating RA, MB and intravascular lithotripsy may optimise the management of calcified coronary lesions.