Letter: The ROTA-CUT randomised trial: push the button harder

In a recent issue of EuroIntervention, Sharma et al presented the results of the ROTA-CUT trial1. The aim of this study was to investigate whether combining rotational atherectomy with a cutting balloon (CB) or a non-compliant balloon (NCB) would result in improved procedural and clinical outcomes. The authors concluded that the results in the two arms were quite comparable, regardless of the strategy employed. However, the study does have some major limitations that could potentially convey an incomplete picture. In the study, the CB was used in accordance with the manufacturer’s instructions: the inflation pressure, as recommended, was 6 atm; and the balloon was sized 1:1 relative to the reference vessel diameter. In the earlier Cutting balloon to Optimize Predilation for Stent implantation (COPS) trial2, which evaluated the use of the CB for the treatment of moderate to severe coronary calcifications, results showed that the benefits of this device became evident when a high-pressure inflation strategy was tilized (18.3±5 atm), along with a 0.5 mm reduction in balloon size compared to the media-to-media diameter. In the COPS trial,...