Koifman E, et al. - Safety, as well as efficacy of rotational and orbital atherectomy (RA and OA) during percutaneous coronary intervention (PCI), was compared among all-comer population with severely calcified lesions. As treatment options for calcified coronary lesions, both RA and OA showed similar safety and efficacy profiles. In addition, intracoronary imaging was identified to be highly beneficial for detecting coronary injury following atherectomy procedures.

• All patients undergoing PCI with OA or RA in researchers' institution from October 2013 until October 2016, were included.
• Baseline and procedural characteristics along with acute complications rates and postprocedural cardiac enzyme elevation were compared.

• There were 191 RA and 57 OA patients.
• No differences were apparent in baseline characteristics, except for creatinine clearance, which was lower in patients with OA (p=0.01).
• Data showed that OA was more frequent in left anterior descending (LAD) artery lesions (p=0.02), while RA was more common in right coronary artery (RCA) lesions (p=0.01).
• In both groups, intracoronary imaging rates were above 60%.
• Although no difference was reported in periprocedural events, rate of coronary dissections with OA compared with RA (p=0.003) was higher.
• In both groups, similar maximal troponin levels were observed.
• In addition, residual stenosis measured by intravascular ultrasound in 29 patients revealed no significant differences between OA and RA (p=0.58).