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Rotational Atherectomy

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Rotational atherectomy in the subadventitial space to allow safe and successful chronic total occlusion recanalization: Pushing the limit further Prevalence, Presentation and Treatment of 'Balloon Undilatable' Chronic Total Occlusions: Insights from a Multicenter US Registry A Meta-Analysis of Contemporary Lesion Modification Strategies During Percutaneous Coronary Intervention in 244,795 Patients From 22 Studies Rotational atherectomy and new-generation drug-eluting stent implantation Long-term outcomes of rotational atherectomy of underexpanded stents. A single center experience Short-term and long-term clinical outcomes of rotational atherectomy in resistant chronic total occlusion Rotational Atherectomy Followed by Drug-Coated Balloon Dilation for Left Main In-Stent Restenosis in the Setting of Acute Coronary Syndrome Complicated with Right Coronary Chronic Total Occlusion Optical frequency-domain imaging findings to predict good stent expansion after rotational atherectomy for severely calcified coronary lesions Radial Versus Femoral Access for Rotational Atherectomy: A UK Observational Study of 8622 Patients Transverse partial stent ablation with rotational atherectomy for suboptimal culotte technique in left main stem bifurcation
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Original Research2018 Jan 1;91(1):47-52.

JOURNAL:Catheter Cardiovasc Interv. Article Link

Rotational atherectomy in the subadventitial space to allow safe and successful chronic total occlusion recanalization: Pushing the limit further

Huang WC, Teng HI, Chan WL et al. Keywords: ATHY - atherectomy; CTO; CTO - percutaneous coronary intervention; complex PCI; directional/rotational; percutaneous coronary intervention

ABSTRACT


Dissection and re-entry (DR) techniques have played a key role in the increase of success rates of chronic total occlusion (CTO) recanalization. DR usually allows wiring complex occlusions, even in case of important calcification. In extreme cases, such as in balloon failure-to-cross, rotational atherectomy (RA) might be decisive. However, according to experts' recommendations, RA should not be performed in dissection planes because of the high risk of perforation and further extending the dissection, so that its use after DR might be limited. Here, we describe a case of successful right coronary artery CTO recanalization in which, after failure of several antegrade and retrograde techniques, RA was safely performed antegradely in the subadventitial space, thus eventually enabling reverse controlled antegrade and retrograde subintimal tracking (CART). Although the feasibility of RA in CTO percutaneous coronary intervention had already been suggested, this case reports on the novel use of RA to allow further manipulation of the subadventitial space (reverse CART) prior to successful recanalization.