Rotational atherectomy via transradial access in the percutaneous treatment of chronic coronary total occlusion with rare complication of coronary guidewire transection

Introduction C total coronary occlusion remains one of the limitations of percutaneous transluminal coronary angioplasty, and few therapeutic devices are specifically designed to address this problem. Despite advances in device technology, the management of resistant, calcific lesions remains one of the greatest challenges in successful chronic total coronary occlusion intervention. Established techniques to modify calcific lesions include the use of high-pressure non-compliant balloon dilation, cutting-balloons, anchor balloons, Tornus catheter and high speed rotational atherectomy. Rotational atherectomy facilitates in percutaneous coronary intervention for chronic total coronary occlusion with severe calcification. Transradial intervention of chronic total coronary occlusion is increasing in frequency and is associated with lower major vascular access site complications. However, the small size of the radial artery is a major limitation of this technique, especially for rotational atherectomy. We reported a rare case of patient, who had coronary angiography for recurrent chest oppression, complicated with transection of the coronary guidewire during rotational atherectomy in the treatment of coronary chronic total occlusion underwent successful bailout stenting, and intensive care. Causative factors are described and suggestions are proposed to manage this problem.