Background:Heavily calcified coronary artery lesions remain a therapeutic challenge for interventional cardiologists worldwide. Recently, “RotaTripsy” has gained popularity as a calcium modification technique prior to stent implantation, in which operators employ rotational atherectomy (RA) to debulk luminal calcium alongside intravascular lithotripsy (IVL) to fracture deeper concentric calcifications.   Aims:To identify demographics and outcomes of patients undergoing “RotaTripsy”.

Methods:Baseline clinical characteristics, procedural details, in-hospital and 30-day outcomes were recorded and reported from a real-world registry of patients at a single high-volume tertiary centre, in which combined RA and IVL was performed in the same procedure, at the discretion of the primary operator.

Results:From 2020-2022, 57 consecutive patients underwent “RotaTripsy” during percutaneous coronary intervention. This real-world cohort included 23/57 (40%) patients with acute coronary syndrome and 3/57 (5.3%) with ST-elevation myocardial infarction (MI). Additionally, 10/57 (18%) of patients were on dialysis, 20/57 (35%) had unprotected left main coronary artery (LMCA) / LMCA equivalent lesions, 7/57 (12%) had acute heart failure and 9/57 (16%) required intraprocedural intra-aortic balloon pump support. 89.5% of procedures were successful, defined as successful stent delivery and <30% residual angiographic stenosis without in-hospital MACE. Complications included slow/no-reflow (6/57, 11%), cerebrovascular events (3/57, 5.3%), in-hospital MI (5.3%, 3/57) and mortality (5.3%, 3/57). 30-day MI rate was 5.3% (3/57) and mortality rate was 7.0% (4/57).

Conclusions:“RotaTripsy” was successful in facilitating stent delivery and restoring flow, even in a relatively sick real-world cohort. Nevertheless, complication rates remain high, reflecting the challenge of treating these complex patients.