Buddy-wire technique during rotational Atherectomy: Simple and effective solution to achieve strong back-up support

Area of Science:

• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Percutaneous coronary intervention (PCI) is a common treatment for coronary artery disease.
• Severely calcified lesions pose a significant challenge during PCI, often requiring specialized techniques like rotational atherectomy (RA).
• Insufficient guiding catheter support can impede device delivery and lesion crossing, particularly in complex anatomies like the obtuse marginal (OM) branch.

Observation:

• A 52-year-old male patient presented with a severely calcified lesion in the proximal to mid OM branch requiring RA.
• Despite using a 7 Fr extra back-up guiding catheter, the 1.5-mm RA burr could not cross the lesion due to inadequate back-up support.
• A simple adjunctive technique was employed: a supportive wire was placed in the left anterior descending (LAD) artery through the Rotablator's drive-shaft sheath.

Findings:

• This maneuver provided sufficient stabilization of the guiding catheter, enhancing back-up support.
• The RA burr successfully crossed the challenging calcified lesion after the supportive wire placement.
• The technique allowed for successful ablation and subsequent PCI without altering the existing equipment.

Implications:

• This case highlights a simple, safe, and effective method to improve guiding catheter support during RA for complex calcified lesions.
• The technique offers a practical solution for interventional cardiologists facing similar challenges, potentially reducing the need for more complex or time-consuming strategies.
• This approach may enhance procedural success rates and patient safety in challenging PCI cases involving rotational atherectomy.