Abstract
Background : One in three patients undergoing percutaneous coronary intervention (PCI) exhibits moderate or severe coronary artery calcification. Coronary calcification remains a major independent predictor of PCI failure and adverse outcomes. PCI of calcified coronary lesions remains challenging, despite significant improvements in the available tools and techniques. Rotational Atherectomy (RA) is a critical component to improve PCI success in these situations by producing lumen enlargement by physical removal of plaque and reduction in plaque rigidity, thus facilitating dilation Case Illustration: A 73-year-old man with exertional angina was referred to our hospital, with a history of hypertension, diabetes mellitus, ex-smoker and dyslipidemia. Physical exam, electrocardiogram, chest x-rays, and laboratory findings were unremarkable, but transthoracic echocardiogram revealed anterior wall hypokinesis. History of cardiac catheterization outside of our center with angiographic result of left anterior descending (LAD) lesion, highly calcified, non-dilatable on first several POBA attempts. Coronary angiography at our center, revealed diffuse calcification from proximal to distal of the LAD artery with about 90% maximum stenosis in mid LAD. RA (Rotablator, Boston) was then performed with A 1.50 mm burr gradually advanced at 150,000 rpm to passed the lesion. After deployments of stents, final angiogram showed well positioned stents with good distal run-off flow. The patient was uneventful during the procedure and was discharged following day. Discussion: In experienced hands, RA is as safe as standard PCI. RA is as a tool to make PCI possible in complex lesions with moderate or severe calcification when clinical variables make PCI appropriate. Rotablator is a catheter-based interventional cardiology procedure using a high-speed rotational device designed to ablate atherosclerotic plaque and restore luminal patency. This help to facilitate stent delivery, avoiding the barotrauma caused by repeated high-pressure balloon inflations that can lead to vessel dissection or perforation. Atherectomy can be performed safely with optimal burr selection and proper ablation techniques, and as a result, complication rates have been significantly minimized, with few changes in the acute complications reported in contemporary studies.
Highlights
One in every three patients performed percutaneous coronary intervention (PCI) has coronary artery calcification ranging from moderate to severe.[1]
We describe a case of successful PCI for highly calcified lesion in left anterior descending (LAD) using Rotational Atherectomy (RA)
As the population ages, more PCIs are performed on patients at increased risk of developing complicated coronary artery disease, and a recent study discovered that 33% of patients undergoing PCI had moderate to severe coronary calcification.[4] (Figure 2)
Summary
One in every three patients performed percutaneous coronary intervention (PCI) has coronary artery calcification ranging from moderate to severe.[1] In Elderly patient with advance kidney disease and diabetes mellitus, coronary calcification is typical findings.[2] Despite major advancements in the equipments and techniques available, coronary calcification lesion PCI remains daunting. Rotational atherectomy (RA) enables PCI in complex lesions with severe calcification. RA has the ability to effectively modify calcified plaques, resulting in lumen enlargement and plaque stiffness reduction, that enables stent delivery and effectively expands the stent. RA is uncommon due to its technical requirements. RA is as safe as standard PCI in experienced hands. We describe a case of successful PCI for highly calcified lesion in LAD using RA
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