Drug–eluting stent (DES) underexpansion has been reported as an independent factor for restenosis and thrombosis, therefore adequate plaque modification prior to DES implantation is the key of calcified lesion treatment.

From January 2010 to October 2011, a consecutive series of patients with de novo severely calcified lesions undergoing rotational atherectomy (RA) followed by balloon dilatation before DES implantation was analysed. Patients were divided into two groups based on the balloon type before stent implantation: the cutting balloon (ROTACUT group) and the plain balloon (control group).

Thirty patients with 31 severely calcified lesions were identified: 15 patients (with 15 lesions) were included in the ROTACUT group and 15 patients (with 16 lesions) in the control group. There were statistically no differences in the final burr size (1.60 ± 0.18 mm vs. 1.67 ± 0.22 mm, p = 0.332), the maximum (max) balloon diameter before stent implantation (2.93 ± 0.36 mm vs. 2.72 ± 0.42 mm, p = 0.137), the max final balloon diameter (3.33 ± 0.29 mm vs. 3.28 ± 0.44 mm, p = 0.702), and the max final balloon inflation pressure (14.7 ± 2.9 atm vs. 16.4 ± 5.5 atm, p = 0.286). The max balloon inflation pressure before stent implantation was significantly lower in the ROTACUT group (9.7 ± 1.9 atm vs. 14.5 ± 2.9 atm, p < 0.001). Final minimum stent cross–sectional area (CSA) was significantly larger in the ROTACUT group compared to the control group (6.61 ± 1.14 mm² vs. 5.38 ± 1.89 mm², p = 0.036).

RA followed by cutting balloon plaque modification before DES implantation in severely calcified lesions appears to be more efficacious including significantly larger final stent CSA.