Abstract
Chronic total occlusion lesions present a major challenge for the interventional cardiologist. In this case, we report the successful use of rotational atherectomy to facilitate retrograde percutaneous coronary intervention of a complex totally occluded right coronary artery after modification of the proximal cap of the lesion to enable placement of the RotaWire in the vessel architecture.
Highlights
The results of percutaneous coronary interventions (PCI) have dramatically improved in the last decades
Case Reports in Cardiology guide and with the help of stiffer guide wires (Pilot 200, Conquest Pro), the proximal cap of the chronic total occlusion (CTO) lesion was punctured and modified. This eventually facilitated the placement of a RotaWire (Boston Scientific, Marlborough, MA, USA) through the architecture of the occluded vessel followed by rotational atherectomy with a small-sized (1.25 mm) burr
Whilst the feasibility of Rotational atherectomy (RA) in CTO PCI has already been suggested, current practice and recommendations dictate that an attempt at RA should follow confirmation of placement of the guide wire in the true lumen [6]
Summary
The results of percutaneous coronary interventions (PCI) have dramatically improved in the last decades. Despite this improvement, chronic total occlusion (CTO) lesions still remain a major challenge of interventional cardiology due to the complexity of these lesions. Rotational atherectomy (RA) in CTO has found use in situations where balloon or microcatheter advancement poses a challenge following successful guide wire crossing. This approach has been found to be feasible and safe and to increase the procedural success rate in these tough CTO lesions with heavy calcification [2]. Its role in heavily calcified wire-uncrossable lesions is less well established and RA is generally considered contraindicated in these situations
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