Triple-Sequence Rotational-Orbital-Rotational Atherectomy for a Heavily Calcified Left Main Bifurcation

Area of Science:

• Cardiovascular Interventions
• Interventional Cardiology
• Medical Device Technology

Background:

• Heavily calcified left main trunk bifurcation lesions pose significant challenges during percutaneous coronary intervention.
• Optimal lesion preparation is crucial for successful stent deployment and long-term outcomes in complex coronary artery disease.

Purpose of the Study:

• To describe and validate a novel triple-sequence atherectomy technique (rotational-orbital-rotational atherectomy) for heavily calcified left main coronary artery lesions.
• To demonstrate the stepwise morphological transformation of calcified lesions using intravascular ultrasound imaging.

Main Methods:

• A case report detailing the percutaneous coronary intervention of a heavily calcified distal left main trunk lesion.
• Utilized a triple-sequence rotational-orbital-rotational atherectomy (RA-OA-RA) approach.
• Intravascular ultrasound (IVUS) was employed to assess lesion morphology and guide the atherectomy sequence.

Main Results:

• The initial rotational atherectomy (RA) created a bilobular lumen.
• Orbital atherectomy (OA) facilitated wire bias towards the calcified arc.
• The subsequent RA generated an oval lumen shape, enabling optimal stent expansion without the need for burr upsizing.
• Intravascular ultrasound confirmed stepwise morphological transformation of the lesion.

Conclusions:

• The triple-sequence RA-OA-RA atherectomy is a viable strategy for treating heavily calcified left main bifurcation lesions.
• This technique allows for effective lesion modification and facilitates optimal stent deployment.
• This is the first intravascular ultrasound-validated report of the RA-OA-RA sequence demonstrating stepwise morphological transformation in complex left main lesions.