Inhospital and mid-term outcomes of a combining rotational atherectomy with cutting balloon angioplasty for coronary artery calcification: a prospective, randomized, two-center study

Aim . To compare the procedural, inhospital, and mid-term outcomes of two stra­tegies for preparing coronary artery calcification. Material and methods . A clinical analysis of treatment outcomes was performed in 88 patients with severe coronary artery calcification who underwent surgery between 2022 and 2024. Percutaneous coronary intervention with stenting was performed. Patients were randomized 1:1 to calcification preparation using a combining rotational atherectomy with cutting balloon angioplasty or rotational athe­rectomy with high-pressure balloon angioplasty. Two patients (2,2%) underwent surgery for unstable angina, and 86 (97,8%) patients had stable angina. We assessed the procedure technical success, the need to modify the lesion pre­paration strategy, periprocedural complications, and the inhospital and 30-day postoperative periods. Results . Technical success was achieved in 100% of cases in both study groups. However, in 8 patients (18%) who did not achieve optimal calcification preparation criteria, rotational atherectomy and a high-pressure balloon preparation were switched to combining rotational atherectomy with cutting balloon angioplasty. The radial artery was the most common access for endovascular intervention (78,4% of cases). Periprocedural myocardial infarction was not recorded. In all cases, patients were managed conservatively in the postoperative period, and repeat intervention was not required. Conclusion . Combining rotational atherectomy with cutting balloon angioplasty demonstrates comparable safety and efficacy to rotational atherectomy combined with a high-pressure balloon angioplasty. Intravascular ultrasound is a key factor in optimizing treatment strategy and deciding whether to switch strategies. This method can be used as a primary strategy for calcification modification, as well as when high-pressure balloon angioplasty is ineffective.