One-man bailout technique for high-speed rotational atherectomy—assisted percutaneous coronary intervention in an octogenarian

摘要

Heavily calcified coronary lesions continue to represent a challenge for percutaneous coronary intervention (PCI), as they are difficult to dilate, and it is difficult to deliver and implant drug-eluting stents (DES) properly. Poor stent deployment is associated with high rates of periprocedural complications and suboptimal long-term clinical outcomes. Thanks to the introduction of several adjunctive PCI tools, like cutting and scoring balloons, and to the novel intravascular lithotripsy technology, the treatment of such lesions has become increasingly feasible, predictable and safe. However, 360° concentric superficial calcification with inability to cross the calcified lesion with a balloon mandates the use of rotational or orbital atherectomy, which can be safely performed via the transfemoral or transradial approach. In this technical note, we report our initial experience of the “one-man” bailout high-speed rotational atherectomy (HSRA) technique, whereby the operator both advances the HSRA device and keeps the distal wire in place.