Rotary atherectomy: Method of preparation of heavily calcified coronary artery lesions

Abstract

Calcified lesions of coronary arteries still represent a major challenge in interventional cardiology. The sign is advanced atherosclerosis, associated with multivessel disease and the presence of complex lesions, including long lesions, chronic total occlusions, and bifurcations. Today, there are several strategies for modifying calcified lesions before percutaneous coronary intervention. They can be divided into strategies without atherectomy and strategies with atherectomy. Non-atherectomy strategies include modification balloons and intravascular lithotripsy. Atherectomy strategies are aimed at physical plaque removal and include rotary atherectomy, coronary orbital atherectomy, and laser coronary atherectomy. Rotational atherectomy is an endovascular procedure during which plaque ablation occurs by advancing a rotating abrasive burr. The use of rotational atherectomy in severely calcified lesions is associated with greater dilatation of vessel diameter, larger lumen cross-section, and fewer final residual stenoses after stent implantation. Heavily calcified ostial and bifurcation lesions are more demanding for percutaneous intervention, with frequent complications such as plaque transfer, acute side branch occlusion, and suboptimal stent apposition or expansion. In such cases, interventions with modification of the calcified plaque with the use of rotational atherectomy have been shown to be more successful, whether only the main branch or both the main and side branches are treated. This paper presents a patient with a calcified lesion of the ostium of the anterior descending artery who refused cardiosurgical revascularization and in whom the initial percutaneous coronary intervention was not successfully performed. After that, percutaneous coronary intervention was performed using rotary atherectomy. An optimal angiographic result with normal coronary flow was obtained. The patient was discharged after the intervention without complications. Carefully performed rotational atherectomy can be successfully used in the treatment of demanding calcified lesions of the ostial segments of the coronary arteries with a high degree of effectiveness and safety.