Rotorbitripsy: "Ménage à Trois" for the Management of Coronary Calcification

Area of Science:

• Interventional Cardiology
• Cardiovascular Imaging
• Biomedical Engineering

Background:

• Management of severely calcified coronary lesions remains challenging, often leading to poor outcomes.
• Novel calcium modification techniques show promise but require further investigation.
• Current evidence is largely based on observational studies.

Purpose of the Study:

• To report the first case of combined use of three calcium modification techniques.
• To illustrate the synergistic application of rotational atherectomy, orbital atherectomy, and intravascular lithotripsy.
• To demonstrate the impact of these techniques on calcified plaque using optical coherence tomography.

Main Methods:

• A single-case report detailing the procedural steps.
• Utilized rotational atherectomy for calcium modification.
• Employed orbital atherectomy for further plaque modification.
• Applied intravascular lithotripsy to address residual calcification.
• Assessed plaque morphology and treatment effect with optical coherence tomography (OCT).

Main Results:

• Successful combined application of rotational atherectomy, orbital atherectomy, and intravascular lithotripsy in a complex calcified lesion.
• Optical coherence tomography visualization confirmed the direct impact of each technique on the calcified plaque.
• Achieved favorable lesion preparation for subsequent intervention.

Conclusions:

• The combined use of rotational atherectomy, orbital atherectomy, and intravascular lithotripsy represents a novel and potentially effective strategy for managing severely calcified coronary lesions.
• Optical coherence tomography is crucial for visualizing and understanding the effects of these techniques.
• This case highlights a harmonized approach to complex lesion management.