Mehta Ashwin B, Desai Ajit, Mehta Nihar
Interventional Cardiologist, Director of Cardiology, Jaslok Hospital and Research Centre, 15 Dr. G. D. Deshmukh Marg, Mumbai 400026, India.
Indian Heart J. 2013 Jul-Aug;65(4):469-73. doi: 10.1016/j.ihj.2013.06.011. Epub 2013 Jul 24.
Rotational atherectomy is contraindicated in dissected coronary arteries since it can lead to progression of the dissection or perforation. In our case, the right coronary artery (RCA) arose anomalously from the left coronary sinus. The lesion in the RCA was an undilatable calcified one. There was a dissection in the RCA due to high pressure balloon dilatation. Since the patient was hemodynamically unstable and there were no options besides rotablation, we proceeded with caution. Rotablation and stenting were successfully done. Our case report highlights the importance of the need for good guide catheter support even in the presence of anomalously arising arteries and the rotablation option for unyielding calcified coronary lesions, even in the setting of a dissection.
旋磨术在冠状动脉夹层时是禁忌的，因为它可导致夹层进展或穿孔。在我们的病例中，右冠状动脉（RCA）起源异常，起自左冠状窦。RCA中的病变是不可扩张的钙化病变。由于高压球囊扩张，RCA出现了夹层。由于患者血流动力学不稳定，且除旋磨术外别无选择，我们谨慎地进行了操作。旋磨术和支架置入术均成功完成。我们的病例报告强调，即使存在动脉起源异常，良好的引导导管支撑也很重要，并且对于顽固的钙化冠状动脉病变，即使在夹层情况下，旋磨术也是一种选择。
