title: Successful rotational atherectomy in the setting of extensive coronary dissection: a case of failed balloon angioplasty in a nondilatable calcified lesion complicated by balloon rupture and extensive dissection.
abstract: We describe a case of rotational atherectomy (RA) used in the setting of extensive coronary dissection. Unsuccessful predilitation of a heavily calcified proximal LAD stenosis resulted in balloon rupture, which produced occlusive dissection extending into the mid LAD. Limited options for this patient required that we perform RA to permit stent delivery and deployment and avoid anterior myocardial infarction. A brief discussion of reasons for balloon angioplasty failure and the potential role for subsequent RA is given. Predictors for coronary perforation when performing RA are reviewed. Our rationale and strategy to avoid the increased risk of perforation with RA in this contraindicated setting of extensive dissection is given.
authors.affiliation: Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
authors.forename: Wesley R
authors.initials: WR
authors.lastname: Pedersen
authors.forename: Irvin F
authors.initials: IF
authors.lastname: Goldenberg
authors.forename: Randall K
authors.initials: RK
authors.lastname: Johnson
authors.forename: Michael R
authors.initials: MR
authors.lastname: Mooney
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D017225:Atherectomy, Coronary / Q000379:methods*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000628:therapy; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy; D003331:Coronary Vessels / Q000293:injuries; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018570:Risk Assessment; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014654:Vascular Patency