title: Dislocation of the rotating cutter during directional coronary atherectomy: a note of caution.
abstract: Directional coronary atherectomy (DCA) has received increased attention, especially as a bail-out procedure after failed balloon angioplasty. However, this technique may also be burdened by severe pitfalls. We report a patient with a balloon-resistant left coronary artery lesion subsequently treated with DCA. Despite its over-the-wire guidance, as the rotating cutter was advanced, it deviated from its intra-housing course and intruded into the vascular wall. Dislocation of the rotating blade was due to pressure from hard plaque tissue. After having carefully pulled back the complete catheter system, a severe spasm of the left main stem occurred, which was reversed by intracoronary nitroglycerine. The final angiography showed a left coronary artery without significant, residual stenosis. The case report underscores that DCA passes must be performed under continuous fluoroscopic control, especially for balloon-resistant lesions because of the unpredictability of DCA-imminent complication.
authors.affiliation: Department of Internal Medicine I, University of Munich, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Bauriedel
authors.forename: S
authors.initials: S
authors.lastname: Schluckebier
authors.forename: U
authors.initials: U
authors.lastname: Welsch
authors.forename: K
authors.initials: K
authors.lastname: Werdan
authors.forename: B
authors.initials: B
authors.lastname: Höfling
mesh_terms: D017225:Atherectomy, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D003329:Coronary Vasospasm / Q000188:drug therapy / Q000209:etiology; D004868:Equipment Failure; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin