Role of Rotational Atherectomy in Complex PCI: A Case Report

Background: Approximately one in every three patients performed percutaneous coronary intervention (PCI) has coronary artery calcification ranging from moderate to severe. Coronary calcification is significant independent predictive factor for PCI failure and adverse outcomes. Rotational Atherectomy (RA) is a component of improving PCI success by physically removing plaque and reducing its rigidity, thereby facilitating dilation. Objective: This case report was role of rotation atherectomy in complex PCI Case: A 73 year old man was referred to our hospital with exertional angina. He had history of hypertension, diabetes mellitus, smoker, and dyslipidaemia. The physical examination, electrocardiogram, chest x-rays, and laboratory results were all normal, but the transthoracic echocardiogram revealed anterior wall hypokinesis. Coronary angiography performed outside of our center found a left anterior descending (LAD) lesion that was highly calcified and undilatable during the initial attempts. Repeat angiography performed at our center revealed diffuse calcification from the proximal to distal LAD artery, with a maximum stenosis of approximately 90% in the mid LAD. The lesion was then passed using RA. Following stent deployment, the final angiogram revealed well-positioned stents with adequate distal flow. Conclusion: In skilled hands, RA is as safe as standard PCI. In complex moderate to severe calcified lesions, RA is used to facilitate PCI when clinical factors indicate PCI is reasonable. RA utilizes a high-speed rotational device to ablate atherosclerotic plaque and restore luminal patency. With proper burr selection and ablation techniques, atherectomy can be performed safely, and as a result, complication rates have been significantly reduced.