Rotablating the Un-dialatable Lesions

The patient was counselled, and right femoral access was established with a 7F femoral sheath. The Left main was cannulated with a 7F XB 3.5 guide catheter and the lesion was crossed with a 0.014" workhorse PTCA guide wire. IVUS and OCT catheters did not cross the lesion (Figure 3). Pre-dilatation was attempted with a NC balloon (2.25x12mm) at 24 atms (Figure 4), with absolutely no effect. At this stage we decided to ablate the stent at the site of ISR to make way for further intervention. A Rota floppy wire was parked in the LAD and a 1.5mm burr was used at a speed of 180,000 RPM for short intervals, much shorter contact times than normal calcific lesion modification, keeping in mind the heat generated from this (Figure 5). After many short bursts for almost 4 mins, the burr punched through (Figure 6). This was followed by post dilatations with multiple NC balloons, two of which ruptured. Finally NC balloons (3.0x8mm & 3.0x9mm) at 24 atms for 15 seconds gave a fair result (Figure 7), (Figure 8). There was now a decent channel with TIMI 2 flow without any signs of dissection or any other complications (Figure 9). The lesion was then dilated with a scoring balloon (3.0x10mm) at 16 atms for 18 secs (Figure 10), ensuring good lesion bed preparation (Figure 11). A DES (3.0x18mm) was successfully deployed at 18 atms with prolonged inflation for 18 secs (Figure 12). The end result was excellent with no residual narrowing and TIMI 3 flow (Figure 13), (Figure 14), (Figure 15).