PMC7290249_01
(a) Left anterior oblique view (45 ), severely tortuous vessel (arrowhead), (b) right anterior oblique view (30 ), severely tortuous vessel (arrowhead), (c) insufficient balloon expansion (arrowhead), and (d) IVUS findings. IVUS showed that the entire circumference inside the stent was heavily calcified. The lumen was extremely small even after balloon angioplasty using a 3.0 mm balloon. Debulking of the calcification was needed for enough balloon dilatation.
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A 68-year-old man underwent PCI for an in-stent total occlusion of a severe tortuous right coronary artery (RCA) (Figure 1(a) and (b)). INTECC, Japan) with microcatheter backup. After the guide wire successfully crossed the lesion, we performed balloon angioplasty using a 3.0 mm balloon throughout the lesion; however, the distal part of the RCA could not expand sufficiently after balloon dilatation (Figure 1(c)). Intravascular ultrasound (IVUS) revealed heavy calcification inside the stent (Figure 1(d)); therefore, we decided to use an atherectomy device.
(a) RA with a 1.5 mm burr through the GE catheter, (b) Insufficient balloon expansion after RA (arrowhead), (c) OAS through the GE catheter, (d) IVUS findings after OAS, and (e) final angiography.. IVUS: intravascular ultrasound; RA: rotational atherectomy; OAS: orbital atherectomy system.
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We introduced a 7-Fr GE catheter (GuidezillerTM, Boston Scientific, Natick, MA, USA) beyond the proximal vessel tortuosity and performed RA, initially using a 1.5 mm burr (Figure 2(a)). However, the 3.5 mm cutting balloon could not expand sufficiently after that (Figure 2(b)). Therefore, we switched to using the OAS with low speed (50,000 r/min), and we performed eight passes of OAS at the speed of 1 mm/s (Figure 2(c)); after balloon dilatation, IVUS revealed an enlarged lumen area (Figure 2(d)). Final angiography showed no residual stenosis (Figure 2(e)).