title: How Should We Perform Rotational Atherectomy to an Angulated Calcified Lesion?
abstract: Rotational atherectomy to an angulated calcified lesion is always challenging. The risk of catastrophic complications such as a burr becoming stuck or vessel perforation is greater when the calcified lesion is angulated. We describe the case of an 83-year-old female suffering from unstable angina. Diagnostic coronary angiography revealed an angulated calcified lesion in the proximal segment of the right coronary artery. We performed rotational atherectomy to the lesion, but intentionally did not advance the rotational atherectomy burr beyond the top of the angulation. We controlled the rotational atherectomy burr and stopped it just before the top of the angulation to avoid complications. Following rotational atherectomy, balloon dilatation with a non-compliant balloon was performed, and drug-eluting stents were successfully deployed. In this manuscript, we provide a review of the literature on this topic, and discuss how rotational atherectomy to an angulated calcified lesion should be performed.
authors.affiliation: Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sakakura
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Taniguchi
authors.forename: Mitsunari
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Momomura
authors.forename: Hideo
authors.initials: H
authors.lastname: Fujita
mesh_terms: D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods; D017225:Atherectomy, Coronary / Q000009:adverse effects / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery