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CASE20191029_008
| CORONARY - Complications | |
| My First Rota Wire Brake and Successful Bailout Case | |
| Hiroaki Matsuda1, Takahiro Tokuda1, Yoriyasu Suzuki1, Tatsuya Ito1 | |
| Nagoya Heart Center, Japan1, | |
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[Clinical Information]
- Patient initials or identifier number:
S.K
-Relevant clinical history and physical exam:
A 64-year-old male with dyslipidemia and diabetes mellitus was admitted with exertional chest pain (CCS¥²). The symptom was gradually worsening and he visited our hospital. He was diagnosed with stable angina pectoris from following several findings.
-Relevant test results prior to catheterization:
Electrocardiogram at rest showed no significant findings, but treadmill exercise test showed ischemic findings. Echocardiography showed no significant findings with good wall motion. Ejection fraction was about 60% in the modified Simpson method.
- Relevant catheterization findings:
Coronary angiography (CAG) showed tandem moderate stenosis at right coronary artery seg.1-2 and diffuse moderate-severe stenosis with severe calcification at left anterior artery (LAD) seg.6-7. Following that, fractional flow reserve for the both stenoses was measured and showed positive only for the LAD (0.62). Therefore, elective percutaneous coronary intervention for the LAD calcified lesion was scheduled.
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[Interventional Management]
- Procedural step:
Left radial artery access was selected and a guiding catheter (Launcher 7Fr EBU3.5 SH, Medtronic) was engaged through a 6Fr glidesheath. After a floppy guidewire (SION blue ES, ASAHI INTECC) was crossed for LAD distal portion, the LAD lesion was observed with optical frequency domain imaging (OFDI). The OFDI findings demonstrated diffuse severe calcified lesion as expected. The SION blue ES guidewire was changed for a rota wire (RotaWire Floppy, Boston Scientific) through a microcatheter (Caravel MC, ASAHI INTECC) and rotational atherectomy was started with burr1.75 politely. However, in the middle procedure, some strange sound and touch feeling was admitted. The procedure was stopped and again imaging OFDI was performed. From the OFDI finding, the rota wire was broken in the LAD mid. At first, the wire snare technique was tried with three different floppy wires, but the procedure was failed. Next, the ¡°real¡± snare technique with a microbasket (Soutenir CV, ASAHI INTECC) was tried and successful for removing the broken rota wire. After that, a cutting balloon (Wolverrine CB 2.5/10, Boston Scientific) was dilated for the calcified lesion and two DESs was deployed. Final OFDI and CAG suggested no complication and the procedure could be finished safe.
 XA0018.mov XA0030.mov XA0097.mov- Case Summary:
We experienced the tough LAD diffuse severe calcified case and the rota wire brake for the first time. When you feel something different from usual with the rotablator, you should stop it and consider the situation carefully. In this case, there was high risk of removing the rota wire because of creating vessel tear. The vessel tear might lead perforation, tamponade and cardiac arrest in the worst case. If you think the worst case, you should put a stent on the rota wire. Also, the Soutenir CV microbasket is one option of removing the stuck things in coronary artery.
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