Safety and efficacy of rotational atherectomy in heavily calcified lesions involving coronary aneurysms

Percutaneous transluminal rotational atherectomy (PTRA) is one of the most used techniques to facilitate percutaneous coronary intervention in heavily calcified coronary lesion (CCL). Coronary aneurysms (CAs) are detected in 1.2-4.9% of coronary angiogram. The presence of CA and CCL is infrequent but not rare, where the use of PTRA may be mandatory despite the high risk. After a complex procedure of PTRA in a CCL with CA we decided to investigate about this particular condition. We identified a total of six patients among 174 consecutive percutaneous coronary intervention (3.4%). All the procedures showed good stent expansion in the absence of major complications, such as no-reflow or coronary perforation. Cardiovascular death, rehospitalization for myocardial infarction and target lesion failure were not reported at follow-up (252 +/- 152 days). Lay abstract Fat and other substances can build up within blood vessels and block them. There are a few ways to remove this blockage, including a procedure known as percutaneous transluminal rotational atherectomy (PTRA). During PTRA, doctors use a rotating catheter (a soft, hollow tube) whose tip is covered with fine diamond crystals. This will help to vaporize the buildup. However, this process can have some complications, especially when carried out in fragile blood vessels. This paper describes a patient where PTRA was performed in a fragile blood vessel and goes on to investigate other occurrences of this high-risk procedure. We were able to find six patients out of 174 procedures performed at two hospitals in Italy. All of these patients did not have serious side effects from their operation.