Should We Still Do Plain Old Balloon Angioplasty following Rotational Atherectomy in Drug-Eluting Stent Era?

Abstract Background Drug-eluting stent (DES) is well known effective in severely calcified lesion after rotational atherectomy (ROTA). However, there are still some situations when metal stents should be avoided and plain old balloon angioplasty (POBA) emerges as the preferred option. The aim of present study is to explore that whether POBA is comparably effective to DES in large and calcified coronary pretreated by ROTA in clinical outcomes. Methods A retrospective analysis of consecutive patients treated for severely calcified lesions in large (≥ 3 mm) coronary using ROTA + DES or ROTA + POBA was performed. Major adverse cardiac events (MACE) including all cause/cardiac death and target lesion revascularization (TLR) at 1- and 2-year post-treatment, were compared between groups, with Cox regression analyses to identify independent predictors of TLR and MACE. Results The analysis included 285 cases in the ROTA + DES and 47 in the ROTA + POBA group, while no relevant between-group differences in clinical baseline characteristics were found. Of note, lesion length was greater in the ROTA + DES group (37.2 mm versus 19.3 mm, p < 0.001), with 8.4% lesions being chronic total occlusion in this group, but none in the ROTA + POBA group. The in-hospital/30-day mortality rate (5.3%, DES, and 6.4%, POBA), as well as the 12- and 24-month all-cause/cardiac mortality rate (9.3% and 7.7%, respectively) were not significantly different between groups. TLR rates were not significantly different between groups at 12-month (4.6%, DES, and 4.3%, POBA) and 24-month (5.3%, DES and 6.4%, POBA) respectively. Conclusions Outcomes were comparable for ROTA + DES and + POBA in severely calcified large coronary arteries intervention, with respect to mid-term death or TLR rate, especially for short lesion < 20 mm.