A 68 years-old woman with severe calcified lesion of left anterior descending artery

A 68 year-old woman was referred for rotational atherectomy to our center. Firstly she has been evaluated in another center for atypical chest pain and palpitation. Her palpitation was attributed to a series of wide complex tachycardia for which she has been undergone an electrophysiological (EP) study and a coronary angiogram. Her EP study showed a left septal ventricular tachycardia and the patient received an ablation treatment. Also a severe calcified left anterior ascending artery was prominent in her angiography. Due to a heavily calcified lesion, a Rota-stent strategy was planned for the patient. We have chosen a 7F Left Judkins Guiding catheter (Cordis Corporation, Johnson and Johnson, Miami, FL) for intubating the left coronary artery. The rotational atherectomy was performed via Rotablator System (Boston Scientific, Natick, MA, USA) (Figure 1). Following the atherectomy, and before the stenting, the lesion has been predilated with a 2.75 x 15 FAIRWAY balloon catheter (Cordynamic, Switzerland). A 3 x 18 Xience PRIME coronary balloon stent (Abbott Vascular, Chicago, IL) has been chosen. Finally a postdilation 3.5 x 12 MAVERICK balloon catheter (Boston Scientific, Natick, MA, USA) has been performed (Figure 2).

 Despite the early enthusiasm for rotational atherectomy and its potential role for treating complex lesions (1), today we use the strategy only for specific indications (severe calcified lesion, ostial stenosis) (2). Also, it is strongly recommended that the debulking strategy should be followed by a stent placement (3). 

References:    

1.      MacIsaac AI, Bass TA, Buchbinder M, et al. et al. High speed rotational atherectomy: Outcome incalcified and noncalcified coronary artery lesions. J Am Coll Cardiol. 1995;26:731–736.

2.      Chen CC, Hsieh IC. Application of rotational atherectomy in the drug-eluting stent era. J Geriatr Cardiol. 2013:213–216.

3.      Jiang J, Sun Y, Xiang M, et al. et al. Complex coronary lesions and rotational atherrectomy: one hospital\'s experience. J Zhejiang Univ-Sci B (Biomed & Biotechnol) 2012;13:645–651