Clinical Cases in Coronary Rotational Atherectomy: Complex Cases and Complications

Description

This concise practical guide is designed to facilitate the clinical decision-making process in the management of rotational atherectomy procedures by reviewing a number of cases and defining the various diagnostic and management decisions open to clinicians. It will be well illustrated but concise, enabling the reader to obtain relevant information regarding both standard and unusual cases in a rapid, easy to digest format. Each case will also include a narrative description and patient management tips. Rotational atherectomy (‘rotablator’) is used to treat heavily calcified lesions within coronary arteries at the time of percutaneous coronary intervention (PCI). Lesions that are inadequately treated may not be dilatable by balloons; and stents that are implanted in such lesions are at high risk for acute stent thrombosis and stent failure. However, rotablator therapy is high risk and present unique challenges to the interventionalists. Complications are generally uncommon. However, when they do occur, they tend to be disastrous. In this case book, we present a series of rotablator cases: basic, complex cases, difficult cases, complications and unusual situations. Although PCI operators all have some degree of experience with this therapy, each operator is unlikely to have significant experience given the cost of the device and the risk involved. Therefore, this book will provide interventionalists with a valuable compendium of cases which can help them in the management of patients whom they plan to treat with rotational atherectomy. Front Matter ....Pages i-xi Overview of Equipment and Procedure (Jonathan Yap, Khung Keong Yeo, Tina Teo, Reginald Low)....Pages 1-13 Straightforward LAD case (Bradley D. Stauber, Reginald I. Low, Gagan D. Singh)....Pages 15-20 Basic LCX Case (Arie Steinvil, Lowell Satler)....Pages 21-23 Straightforward LAD Case (Bradley D. Stauber, Reginald I. Low, Gagan D. Singh)....Pages 25-32 Ostial RCA (Khaled Hammad, Khung Keong Yeo)....Pages 33-38 Downsizing Burr as a Strategy for Severe Calcific Stenosis (Richard J. Jabbour, Mauro Carlino, Antonio Colombo)....Pages 39-42 Complex LAD (Arie Steinvil, Lowell Satler)....Pages 43-46 Complex Case: Rotational Atherectomy in Preparation for TAVR (Bradley D. Stauber, Reginald I. Low, Jason H. Rogers, Gagan D. Singh)....Pages 47-51 Complex Case: Rotational Atherectomy Involving the Left Main Coronary Artery (Bradley D. Stauber, Reginald I. Low, Gagan D. Singh)....Pages 53-61 Complex Case: LM and LAD (Jiang Ming Fam, Soo Teik Lim)....Pages 63-68 Complex Case: LM and LCX (Arie Steinvil, Lowell Satler)....Pages 69-72 Complex Case: Saphenous Vein Graft (Bradley D. Stauber, Reginald I. Low, Jeffrey A. Southard, Gagan D. Singh)....Pages 73-79 Complex Case: In-Stent Restenosis (Bradley D. Stauber, Reginald I. Low, Jeffrey A. Southard, Gagan D. Singh)....Pages 81-86 Complex Case: High-Risk Acute Coronary Syndrome (Timothy Watson, Hee Hwa Ho, Paul Jau Lueng Ong)....Pages 87-93 Complex Case: Rotational Atherectomy in Myocardial Infarction (Jonathan Yap, Jack Wei Chieh Tan)....Pages 95-100 Complex Case: Rota Gutter in RCA (Bradley D. Stauber, Reginald I. Low, Gagan D. Singh)....Pages 101-106 Complex Case: Rotablation in Distal RCA (Khung Keong Yeo)....Pages 107-112 Complex Case: Rotablation in Cardiogenic Shock (Bradley D. Stauber, Reginald I. Low, Gagan D. Singh)....Pages 113-120 Complex Case: Rotablation in Cardiogenic Shock #2 (Timothy Watson, Paul Jau Lueng Ong)....Pages 121-129 Complex Case: Severe Diffuse LAD Disease (Jiang Ming Fam, Khung Keong Yeo)....Pages 131-136 Complication: No Reflow (Jiang Ming Fam, Khung Keong Yeo)....Pages 137-140 Complication: Trapped Burr (Lucky R. Cuenza, Aaron Wong, Kay Woon Ho)....Pages 141-152 Complication: Sheared Wire (Jonathan Yap, Jack Wei Chieh Tan)....Pages 153-159 Complication: Dislodged Burr (Jonathan Yap, Khung Keong Yeo)....Pages 161-169 Specials: Rotablation Through Stent Accordion (Khung Keong Yeo, Garrett Wong, Reginald Low)....Pages 171-175 Specials: Rotablation Through Jailed LAD (Himanshu Gupta, Khung Keong Yeo)....Pages 177-186 Specials: Rotablation Through LM In-Stent Restenosis (Khaled Hammad, Khung Keong Yeo)....Pages 187-192 Specials: Rotablation of LIMA into LAD (Aaron Wong, Khung Keong Yeo)....Pages 193-200