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Rotational atherectomy to left circumflex ostial lesions: tips and tricks

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Abstract

Serious complications including vessel perforation may occur during rotational atherectomy (RA) to left circumflex (LCX) ostial lesions. In fact, if perforation occurs around LCX ostium, bailout procedures including deployment of covered stents may cause fatal ischemia in the territory of left anterior descending artery, which results in broad anterior acute myocardial infarction and subsequent death. In this review article, we described tips and tricks for RA to LCX ostial lesions. First, we should cautiously decide the indication for RA to LCX ostial lesions, because there are several reasons to avoid RA to LCX ostial lesions. Before procedures, we should estimate the difficulty of RA to LCX ostial lesions, which is mainly determined by the combination of the bifurcation angle and the severity of stenosis. Thus, the combination of the large bifurcation angle and the tight stenosis makes RA to LCX ostial lesions most difficult. Appropriate position of guide catheter and RotaWire is a key to successful RA to LCX ostial lesions. Differential cutting is an essential concept for RA to LCX ostial lesions. However, since there is no guarantee that differential cutting always works, small burr (≤ 1.5 mm) would be a safe choice as initial burr for RA to LCX ostial lesions.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, Saitama, 330-8503, Japan

    Yousuke Taniguchi, Kenichi Sakakura, Hiroyuki Jinnouchi, Takunori Tsukui & Hideo Fujita

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  1. Yousuke Taniguchi
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  2. Kenichi Sakakura
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  3. Hiroyuki Jinnouchi
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  4. Takunori Tsukui
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  5. Hideo Fujita
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Corresponding author

Correspondence to Kenichi Sakakura.

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Conflict of interest

Dr. Sakakura has received speaking honoraria from Boston Scientific; he has served as a proctor for Rotablator for Boston Scientific; and he has served as a consultant for Boston Scientific. Dr. Jinnouchi has received speaking honoraria from Boston Scientific.

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Supplemental movie 1: Initial angiogram. (MP4 14512 KB)

Supplemental movie 2: The 1.5 x 10 mm balloon finally cross the lesion with power position of guide catheter. (MP4 37824 KB)

Supplemental movie 3: Angiography after 1.5 mm balloon dilatation showed better coronary flow. (MP4 13594 KB)

Supplemental movie 4: Before RA, we adjusted the guide catheter to make a coaxial position between the guide catheter and the LCX ostium. (MP4 6349 KB)

Supplemental movie 5: RA with the 1.5-mm burr. Although the 1.5-mm burr almost crossed the lesion after 7 sessions of RA, the back-up of guide catheter was not sufficient to have the 1.5-mm burr completely cross the lesion. (MP4 95419 KB)

Supplemental movie 6: We adjusted the guide catheter to strengthen the back-up force. (MP4 10097 KB)

Supplemental Movie 7: The 1.5-mm burr smoothly cross the whole lesion. (MP4 14630 KB)

Supplemental movie 8: After RA of the 1.5-mm burr, TIMI flow grade 3 was observed. (MP4 17506 KB)

Supplemental movie 9: An IVUS catheter crossed the lesion, and revealed successful differential cutting. (MP4 62637 KB)

Supplemental movie 10: After the burr 2.0-mm RA, an IVUS catheter revealed evidence of additional debulking. (MP4 72743 KB)

Supplemental movie 11: Final angiogram. (MP4 6531 KB)

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Taniguchi, Y., Sakakura, K., Jinnouchi, H. et al. Rotational atherectomy to left circumflex ostial lesions: tips and tricks. Cardiovasc Interv and Ther 38, 367–374 (2023). https://doi.org/10.1007/s12928-023-00941-y

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  • DOI: https://doi.org/10.1007/s12928-023-00941-y

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