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Rotational atherectomy in the subadventitial space to allow safe and successful chronic total occlusion recanalization: Pushing the limit further Rotational atherectomy and new-generation drug-eluting stent implantation Long-term outcomes of rotational atherectomy of underexpanded stents. A single center experience Short-term and long-term clinical outcomes of rotational atherectomy in resistant chronic total occlusion Prevalence, Presentation and Treatment of 'Balloon Undilatable' Chronic Total Occlusions: Insights from a Multicenter US Registry A Meta-Analysis of Contemporary Lesion Modification Strategies During Percutaneous Coronary Intervention in 244,795 Patients From 22 Studies Radial Versus Femoral Access for Rotational Atherectomy: A UK Observational Study of 8622 Patients Rotational Atherectomy Followed by Drug-Coated Balloon Dilation for Left Main In-Stent Restenosis in the Setting of Acute Coronary Syndrome Complicated with Right Coronary Chronic Total Occlusion Optical frequency-domain imaging findings to predict good stent expansion after rotational atherectomy for severely calcified coronary lesions Transverse partial stent ablation with rotational atherectomy for suboptimal culotte technique in left main stem bifurcation
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Clinical Case Study2017 Oct 21;58(5):806-811

JOURNAL：Int Heart J. Article Link

Rotational Atherectomy Followed by Drug-Coated Balloon Dilation for Left Main In-Stent Restenosis in the Setting of Acute Coronary Syndrome Complicated with Right Coronary Chronic Total Occlusion

Shiraishi J, Shoji K, Yanagiuchi T et al. Keywords: Acute myocardial infarction; Intravascular Ultrasound; Percutaneous coronary intervention

ABSTRACT

An 83-year-old man presented with recurrent acute coronary syndrome (ACS) at the left main coronary artery (LMCA) complicated with ostial chronic total occlusion (CTO) in the right coronary artery (RCA) (RCA-CTO). At the first LMCA-ACS approximately 1 year earlier, he had undergone LMCA-crossover stenting with a biolimus-eluting stent in the presence of RCA-CTO. At the second LMCA-ACS, we angiographically confirmed severe in-stent restenosis in the distal LMCA, in addition to angled severe stenosis in the just proximal LCx, and performed primary PCI for the LMCA bifurcation lesion under intra-aortic balloon pumping support. Because of difficulty in crossing a guidewire through the just proximal LCx lesion, we first performed rotational atherectomy against the LMCA in-stent eccentric lesion. After successfully crossing the guidewire into the LCx, we added balloon dilation with kissing balloon inflation followed by alternate drug-coated balloon dilation. An eight-month follow-up coronary angiography revealed no further vessel narrowing in the LMCA bifurcation lesion.
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