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Retrograde Crossing Facilitating Rotational Atherectomy for Recanalization of Uncrossable Near Aorto-Ostial Chronic
Min-Ping Huang1, Chun-Ting Shih1, Hsiu-Yu Fang1
1Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Insights
Navigating calcified chronic total occlusions is challenging. This case demonstrates using guide wire-induced microfractures to advance a rotational atherectomy wire, enabling successful percutaneous coronary intervention in complex coronary lesions.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Devices
Background:
- Calcified near-ostial chronic total occlusions present significant anatomical challenges for percutaneous coronary intervention.
- Successful revascularization of these lesions requires innovative techniques to overcome guidewire crossing difficulties.
Abstract:
Calcified near aorto-ostial chronic total occlusions pose considerable procedural challenges because of their intricate anatomical configuration. This case concerns a 64-year-old uremic woman with a near-ostial chronic total occlusion of the right coronary artery. Following the failure of retrograde RG3 externalization because of an uncrossable lesion, a staged percutaneous coronary intervention was undertaken, employing rotational atherectomy with a RotaWire Extra Support wire (Boston Scientific) that capitalized on microfractures previously created by antegrade and retrograde 0.014-inch guidewires. This case underscores the strategic utilization of guide wire-induced microfractures to facilitate direct RotaWire advancement and illustrates a safe and effective approach for navigating anatomically complex coronary lesions.
