Related Experiment Video
Updated: Aug 1, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Aortic cusp perforation during rotational atherectomy: a case report
Nihit Shah1, Polyvios Demetriades1, Ghaith M Maqableh1,2
1Department of cardiology, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2GW, UK.
Insights
Rotational atherectomy for coronary artery disease can lead to complications like aortic regurgitation. This case highlights the importance of multi-modality imaging for timely intervention and patient management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Rotational atherectomy is increasingly used for coronary artery disease.
- While generally safe, recognized complications exist.
- This case details a novel complication arising from the procedure.
Background:
Rotational atherectomy has become increasingly utilised over the past decade. Although a relatively safe procedure in appropriately trained physicians' hands, there are a number of recognised complications.
Case Summary:
We describe the case of a 64-year-old female who presented with chest pain and was diagnosed with non-ST-segment elevation acute coronary syndrome. A transthoracic echocardiogram (TTE) showed normal biventricular function and no valve disease. Invasive coronary angiogram was performed which revealed a severely calcified ostial right coronary artery (RCA) disease which was felt to be the culprit of the presentation. Balloon dilatation was unsuccessful, therefore, rotational atherectomy with an Amplatz left 0.75 guide and a 1.5 mm rota-burr was utilised and improved calcium burden. This was complicated by ostial dissection, treated with stenting. A TTE following the procedure revealed moderate aortic regurgitation (AR). The patient was discharged as she remained asymptomatic. An outpatient transoesophageal echocardiogram performed eight months later showed evidence of severe eccentric AR. Cardiac magnetic resonance imaging confirmed severe AR with left ventricular dilatation. Repeat angiogram 10 months after index procedure revealed in-stent restenosis, and the patient was accepted by heart multidisciplinary team for aortic valve replacement and grafting of RCA.
Discussion:
As the field of rotational atherectomy continues to expand, we propose that novel complications such as reported in this case may become recognised. Finally, we stress the importance of multi-modality imaging in the investigation and timely planning of interventions in the management of these patients.
