Hydrodynamic Contrast Recanalization-Facilitated Rotational Atherectomy to Treat a Heavily Calcified Coronary Chronic...

Percutaneous coronary intervention (PCI) for heavily calcified chronic total occlusion (CTO) remains among the most challenging procedures in interventional cardiology. Hydrodynamic contrast recanalization (HDR) is a novel crossing technique for CTO that uses intraplaque contrast microinjections in the proximal CTO to facilitate the passage of polymer jacketed wires. The use of HDR combined with rotational atherectomy (RA) during CTO PCI in heavily calcified arteries has not been described.

A 72-year-old man with refractory angina was referred for revascularization of a chronically occluded ramus intermedius. The presence of heavy calcium and flush occlusion of the left main artery necessitated antegrade and retrograde HDR to complete the wire crossing. RA was then performed to facilitate delivery of equipment across the calcified CTO and complete the procedure.

This is to our knowledge the first case to describe the combination of HDR and RA in complex CTO PCI. Compared to traditional contrast modulation techniques, HDR facilitates intraplaque wire crossing, making it particularly suitable for treating calcified arteries with plaque modification therapies such as RA.