Researchers successfully perform ostial right coronary artery CTO recanalization using rotational atherectomy in subintimal space
USA: There has always been a controversy about performing atherectomy in the subintimal space. In a recent case study published in Cardiovascular Revascularization Medicine, the researchers described successful ostial right coronary artery CTO (chronic total occlusion) recanalization using rotational atherectomy in subintimal space.
Severely calcified ostial CTO percutaneous coronary intervention (PCI) is challenging with a high prevalence of balloon uncrossable lesions. Despite the higher aortic dissection and perforation risk, rotational atherectomy (RA) may be used as a bailout strategy for uncrossable lesions. The authors note that the objective is to modify the subintimal space with dissection and re-entry (DR) techniques in the ostial/proximal coronary segment to advance the devices and cross the proximal CTO cap.
Marcelo Harada Ribeiro, SOS Cardio Hospital, Florianopolis, SC, Brazil, and colleagues describe the successful use of subintimal RA in a balloon-uncrossable ostial right coronary artery (RCA) CTO in a 78-year-old man.
The man had a history of CABG (coronary artery bypass surgery) 10 years ago and presented with medically refractory angina. After a failed previous attempt, he was referred for RCA CTO PCI. Coronary angiography showed a severely calcified ostial RCA occlusion filling by septal collaterals from the left anterior descending artery (LAD). There were patent saphenous vein grafts (SVGs) to the left anterior descending (LAD) and the ramus.
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