Emergency bail-out stenting for major coronary dissection complicating rotational atherectomy

The problems of restenosis and abrupt occlusion following percutaneous transluminal coronary angioplasty (PTCA) remain a challenge. Restenosis occurs in 30-50% of lesions treated and substantially erodes the potential advantage of percutaneous treatment of obstructive coronary disease over alternative revascularisation strategies. Abrupt closure occurs in 5-7% of cases with significant associated morbidity and mortality. Up to 35% of patients require emergency bypass surgery for treatment of abrupt closure and more than half sustain a perioperative myocardial infarction. By debulking atherosclerotic lesions, atherectomy offers the potential to reduce restenosis. Coronary stenting, by acting as a scaffolding can sometimes solve the problem of abrupt closure due to intimal dissection. We report the use of emergency placement of multiple coronary stents for obstructive coronary dissection complicating rotational atherectomy.