Rotational atherectomy of a specific lesion: a case report

    Authors

    Keywords

    coronary artery calcification, percutaneous coronary intervention, rotational atherectomy

    DOI

    https://doi.org/10.15836/ccar2026.14

    Full Text

    **Introduction:** Coronary artery calcification (CAC) complicates percutaneous coronary intervention (PCI) by impairing stent delivery and expansion (1). Currently, in the battle against CAC, several tools are available, which can be divided into modified balloons, atheroablative technologies, and intravascular lithotripsy (IVL) (2). Rotational atherectomy (RA) facilitates lesion modification but carries specific risks. RA of o specific lesions: ostial right coronary artery (RCA), ostial left circumflex (LCX) with substantial bending, unprotected left main, diffuse long lesions can be very challenging. Since clinical outcomes of RCA ostial lesions have been unsatisfactory for decades, RA has been a good indication for RCA ostial lesions with severe calcification (3). **Case report:** Seventy-eight years old years female patient was admitted because of unstable angina pectoris. Urgent angiography showed severe calcified ostial RCA lesion. The first attempt at PCI was unsuccessful due to the lack of coaxial positioning of the guiding catheter. Finally, in a second attempt, a successful PCI RCA with single stent implantation was performed. The use of a long, 7-French femoral sheath (Destination Guiding Sheath, Terumo) was crucial for successful maneuvering and coaxial positioning of the guiding catheter. Lesion preparation was done with a 1.25 burr and non-compliant balloons (**Figures 1-3**Figure 2Figure 3). FIGURE 1. Calcified ostial right coronary artery lesion. FIGURE 2. The passage of the burr. FIGURE 3. Final angiogram after stent implantation. **Conclusion:** Reason why RA for RCA ostial lesions are difficult are impossibility of insertion guiding catheter to RCA coaxially and difficulties keeping catheter coaxial to RCA in aorta. Also, coaxial cannot be confirmed by left oblique view which is the standard projection for RA of RCA. There is additional risk of cerebral infarction, so it is important to use small burrs to minimize the size of debris. Although it is demanding and challenging, RA has been a good indication for RCA ostial lesions with severe calcification (3).

    Literature

    1. Barbato E, Carrié D, Dardas P, Fajadet J, Gaul G, Haude M, et al. European Association of Percutaneous Cardiovascular Interventions. European expert consensus on rotational atherectomy. EuroIntervention. 2015 May;11(1):30–6. https://doi.org/10.4244/EIJV11I1A6
    2. Frizzell J, Kereiakes DJ. Calcified plaque modification during percutaneous coronary revascularization. Prog Cardiovasc Dis. 2025 January-February;88:39–52. https://doi.org/10.1016/j.pcad.2024.12.001
    3. Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, et al. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023. Cardiovasc Interv Ther. 2023 April;38(2):141–62. https://doi.org/10.1007/s12928-022-00906-7
    Cardiologia Croatica
    Back to search

    Rotational atherectomy of a specific lesion: a case report

    Extended Abstract
    Issue1-2
    Published
    Pages14-15
    PDF via DOIhttps://doi.org/10.15836/ccar2026.14
    coronary artery calcification
    percutaneous coronary intervention
    rotational atherectomy

    Authors

    Domagoj Mišković*ORCIDGeneral Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia
    Krešimir GabaldoORCIDGeneral Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia
    Josip SilovićORCIDGeneral Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia
    Ivica DunđerORCIDGeneral Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia
    Zrinko PešutORCIDGeneral Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia
    Antonija RagužORCIDGeneral Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia
    Ivan BitunjacORCIDGeneral Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia
    Domagoj VučićORCIDGeneral Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia
    Marijana Knežević PravečekORCIDGeneral Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia
    Katica Cvitkušić LukendaORCIDGeneral Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia

    *Correspondence email: domagoj1304@gmail.com

    Full Text

    Introduction: Coronary artery calcification (CAC) complicates percutaneous coronary intervention (PCI) by impairing stent delivery and expansion (1). Currently, in the battle against CAC, several tools are available, which can be divided into modified balloons, atheroablative technologies, and intravascular lithotripsy (IVL) (2). Rotational atherectomy (RA) facilitates lesion modification but carries specific risks. RA of o specific lesions: ostial right coronary artery (RCA), ostial left circumflex (LCX) with substantial bending, unprotected left main, diffuse long lesions can be very challenging. Since clinical outcomes of RCA ostial lesions have been unsatisfactory for decades, RA has been a good indication for RCA ostial lesions with severe calcification (3).

    Case report: Seventy-eight years old years female patient was admitted because of unstable angina pectoris. Urgent angiography showed severe calcified ostial RCA lesion. The first attempt at PCI was unsuccessful due to the lack of coaxial positioning of the guiding catheter. Finally, in a second attempt, a successful PCI RCA with single stent implantation was performed. The use of a long, 7-French femoral sheath (Destination Guiding Sheath, Terumo) was crucial for successful maneuvering and coaxial positioning of the guiding catheter. Lesion preparation was done with a 1.25 burr and non-compliant balloons (Figures 1-3Figure 2Figure 3).

    FIGURE 1. Calcified ostial right coronary artery lesion.

    FIGURE 2. The passage of the burr.

    FIGURE 3. Final angiogram after stent implantation.

    Conclusion: Reason why RA for RCA ostial lesions are difficult are impossibility of insertion guiding catheter to RCA coaxially and difficulties keeping catheter coaxial to RCA in aorta. Also, coaxial cannot be confirmed by left oblique view which is the standard projection for RA of RCA. There is additional risk of cerebral infarction, so it is important to use small burrs to minimize the size of debris. Although it is demanding and challenging, RA has been a good indication for RCA ostial lesions with severe calcification (3).

    Literature

    1. 1.
      Barbato E, Carrié D, Dardas P, Fajadet J, Gaul G, Haude M, et al. European Association of Percutaneous Cardiovascular Interventions. European expert consensus on rotational atherectomy. EuroIntervention. 2015 May;11(1):30–6.DOI
    2. 2.
      Frizzell J, Kereiakes DJ. Calcified plaque modification during percutaneous coronary revascularization. Prog Cardiovasc Dis. 2025 January-February;88:39–52.DOI
    3. 3.
      Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, et al. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023. Cardiovasc Interv Ther. 2023 April;38(2):141–62.DOI