Transradial rotablation in a patient with dextrocardia and acute ST-elevation myocardial infarction

An 82-year-old gentleman with situs inversus and dextrocardia was admitted to our unit following thrombolysis for inferior ST-elevation myocardial infarction (STEMI). Due to ongoing ischemic symptoms, he underwent emergency transradial coronary angiography. His culprit right coronary artery (RCA) was heavily calcified with severe stenosis in the mid and distal segments. Therefore, rotational atherectomy was performed for debulking, and four drug eluting stents were deployed in the RCA. To the best of our knowledge, this is the first reported case of successful transradial rotablation percutaneous coronary intervention in acute STEMI in a patient with dextrocardia. We also did not use temporary pacemaker wire insertion (TPW) because of the risk of right ventricular perforation (RV) in inferior STEMI with RV involvement.