Successful rotational atherectomy in the setting of extensive coronary dissection: A case of failed balloon angioplasty in a nondilatable calcified lesion complicated by balloon rupture and extensive dissection

• Published in: Catheterization and cardiovascular interventions Vol. 59; no. 3; pp. 329 - 332
• Main Authors: Pedersen, Wesley R., Goldenberg, Irvin F., Johnson, Randall K., Mooney, Michael R.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-07-2003; Wiley-Liss
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - instrumentation; Angioplasty, Balloon, Coronary - methods; Atherectomy, Coronary - methods; balloon rupture; Biological and medical sciences; Calcinosis - diagnostic imaging; Calcinosis - therapy; Coronary Angiography - methods; coronary dissection; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - etiology; Coronary Restenosis - therapy; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - therapy; Coronary Vessels - injuries; Diseases of the cardiovascular system; Equipment Failure; failed angioplasty; Female; Follow-Up Studies; Humans; Medical sciences; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk Assessment; rotational atherectomy; Rupture, Spontaneous - diagnostic imaging; Rupture, Spontaneous - etiology; Rupture, Spontaneous - surgery; Severity of Illness Index; Treatment Outcome; Vascular Patency; Human; failed angioplasty; rotational atherectomy; Prognosis; Coronary artery; Instrumentation therapy; Cuffed tube; Instrumental dilatation; coronary dissection; balloon rupture; Case study; Treatment; Surgery; Tissue rupture; Dissection
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.10552

We describe a case of rotational atherectomy (RA) used in the setting of extensive coronary dissection. Unsuccessful predilitation of a heavily calcified proximal LAD stenosis resulted in balloon rupture, which produced occlusive dissection extending into the mid LAD. Limited options for this patient required that we perform RA to permit stent delivery and deployment and avoid anterior myocardial infarction. A brief discussion of reasons for balloon angioplasty failure and the potential role for subsequent RA is given. Predictors for coronary perforation when performing RA are reviewed. Our rationale and strategy to avoid the increased risk of perforation with RA in this contraindicated setting of extensive dissection is given. Cathet Cardiovasc Intervent 2003;59:329–332. © 2003 Wiley‐Liss, Inc.