Complex Case: Rotablation in Cardiogenic Shock
A 77-year-old man with a history of end-stage renal disease, ischemic cardiomyopathy (LVEF 30%) presented with a non-ST elevation myocardial infarction, and pulmonary edema. Initial right heart catheterization demonstrated that the patient was in cardiogenic shock, with systolic blood pressure of 90 mmHg and cardiac index of 1.5 L/min/m . Coronary angiography demonstrated a calcified left main as well a 90% proximal LAD and 95% circumflex lesion, and PCI was undertaken with rotational atherectomy. This case highlights that rotational atherectomy can be safely performed with experience, good technique, and appropriate planning including hemodynamic support with an intra-aortic balloon pump.