Fracture of coronary guidewire during rotational atherectomy with coronary perforation and tamponade

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Rotational atherectomy is a key treatment for complex coronary artery disease.
• Calcified lesions present unique challenges during percutaneous coronary intervention.
• Coronary artery perforation is a rare but serious complication.

Observation:

• A case involving a calcified right coronary artery lesion with a sharp 90-degree exit angle is presented.
• Rotational atherectomy attempts resulted in guidewire transection and vessel perforation.
• The patient required immediate pericardiocentesis and coronary artery bypass grafting.

Findings:

• The complex anatomy of the lesion contributed to the procedural failure and subsequent perforation.
• Prompt recognition and management were critical for patient survival.
• Literature review confirms the risks associated with rotational atherectomy in challenging lesions.

Implications:

• This case underscores the importance of careful pre-procedural planning for complex coronary interventions.
• It emphasizes the need for experienced operators and readily available emergency surgical support.
• Improved techniques and devices may be necessary to mitigate risks in similar challenging cases.