Overcoming Uncrossable Calcified RCA Using Orbital Atherectomy After Failure of Rotational Atherectomy

Severe calcified lesions in the coronary arteries often pose significant challenges for successful percutaneous coronary interventions. In this case, a 78-year-old woman presented with severe calcific disease in the right coronary artery and underwent two sequential interventions. The initial procedure involved rotational atherectomy but failed to fully cross the lesion. The procedure was complicated by an ostial dissection that was treated by stent. Subsequently, orbital atherectomy was employed, successfully crossing the lesion through a newly deployed ostial stent. Additionally, upfront intracoronary adenosine was administered to prevent no-reflow, achieving optimal procedural outcomes. This case highlights the utility of orbital atherectomy as a rescue technique after failed rotational atherectomy and the effectiveness of proactive pharmacological intervention for no-reflow prevention. To our knowledge there were no case reports addressing successful orbital atherectomy following failed rotational atherectomy.