Clinical Cases in Coronary Rotational Atherectomy: Complex Cases and Complications (Clinical Cases in Interventional Cardiology)

Annotation 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 Preface 6 Contents 8 Chapter 1: Overview of Equipment and Procedure 12 Equipment 13 RotaWire Guidewire and WireClip Torquer 13 Rotaburr 14 Foot Pedal 16 Rotablator Console 16 Rotablator Advancer 18 Procedure 19 Vascular Access, Guide and Burr Selection and Pacing 19 Pre-ablation Setup 20 Burr Positioning 20 Rotablation Procedure 21 Removal of Burr 23 Exchange of RotaWire 24 Chapter 2: Straightforward LAD case 25 Case Summary 25 Discussion and Learning Points 30 Chapter 3: Basic LCX Case 31 Case Summary 31 Discussion and Learning Points 33 Chapter 4: Straightforward LAD Case 34 Case Summary 34 Discussion and Learning Points 41 Chapter 5: Ostial RCA 42 Case Summary 42 Discussion and Learning Points 47 Chapter 6: Downsizing Burr as a Strategy for Severe Calcific Stenosis 48 Case Summary 48 Discussion and Learning Points 51 Chapter 7: Complex LAD 52 Case Summary 52 Discussion and Learning Points 55 Chapter 8: Complex Case: Rotational Atherectomy in Preparation for TAVR 56 Case Summary 56 Discussion and Learning Points 60 Chapter 9: Complex Case: Rotational Atherectomy Involving the Left Main Coronary Artery 61 Case Summary 61 Discussion and Learning Points 68 Chapter 10: Complex Case: LM and LAD 70 Case Summary 70 Discussion and Learning Points 75 Chapter 11: Complex Case: LM and LCX 76 Case Summary 76 Discussion and Learning Points 79 Chapter 12: Complex Case: Saphenous Vein Graft 80 Case Summary 80 Discussion and Learning Points 86 Chapter 13: Complex Case: In-Stent Restenosis 87 Case Summary 87 Discussion and Learning Points 92 Chapter 14: Complex Case: High-Risk Acute Coronary Syndrome 93 Case Summary 93 Discussion and Learning Points 98 Reference 99 Chapter 15: Complex Case: Rotational Atherectomy in Myocardial Infarction 100 Case Summary 100 Discussion and Learning Points 104 References 105 Chapter 16: Complex Case: Rota Gutter in RCA 106 Case Summary 106 Discussion and Learning Points 111 Reference 111 Chapter 17: Complex Case: Rotablation in Distal RCA 112 Case Summary 112 Discussion and Learning Points 116 Chapter 18: Complex Case: Rotablation in Cardiogenic Shock 118 Case Summary 118 Discussion and Learning Points 125 Chapter 19: Complex Case: Rotablation in Cardiogenic Shock #2 126 Case Summary 126 Discussion and Learning Points 133 Chapter 20: Complex Case: Severe Diffuse LAD Disease 135 Case Summary 135 Discussion and Learning Points 139 Chapter 21: Complication: No Reflow 141 Case Summary 141 Discussion and Learning Points 144 Chapter 22: Complication: Trapped Burr 145 Case Summary 145 Discussion and Learning Points 152 References 156 Chapter 23: Complication: Sheared Wire 157 Case Summary 157 Discussion and Learning Points 161 References 163 Chapter 24: Complication: Dislodged Burr 164 Case Summary 164 Discussion and Learning Points 171 Chapter 25: Specials: Rotablation Through Stent Accordion 173 Case Summary 173 Discussion and Learning Points 177 Chapter 26: Specials: Rotablation Through Jailed LAD 178 Case Summary 178 Discussion and Learning Points 186 References 187 Chapter 27: Specials: Rotablation Through LM In-Stent Restenosis 188 Case Summary 188 Discussion and Learning Points 193 Chapter 28: Specials: Rotablation of LIMA into LAD 194 Case Summary 194 Discussion and Learning Points 201 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 This book describes and reviews a multitude of different scenarios in coronary rotational atherectomy. This technique is an integral tool in the coronary interventionalist's armamentarium and is essential in complex coronary interventions. Its use has grown more widespread over the last few years with interventional cardiologists tackling previously 'untreatable' coronary lesions. This has made it ever more important that interventionalists and all involved in the management of patients undergoing this procedure should be given practical information on best practice. Clinical Cases in Coronary Rotational Atherectomy contains over 25 clinical scenarios that reveal the wide extent of patient types, cardiovascular pathology and potential outcomes that the interventionist can experience with it. The book will therefore be of great value to interventional cardiologists, general cardiologists and cardiac surgeons, and all involved in the management of patients undergoing this procedure