Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, Saitama, 330-8503, Japan.
Cardiovasc Interv Ther. 2023 Oct;38(4):367-374. doi: 10.1007/s12928-023-00941-y. Epub 2023 Jun 10.
Serious complications including vessel perforation may occur during rotational atherectomy (RA) to left circumflex (LCX) ostial lesions. In fact, if perforation occurs around LCX ostium, bailout procedures including deployment of covered stents may cause fatal ischemia in the territory of left anterior descending artery, which results in broad anterior acute myocardial infarction and subsequent death. In this review article, we described tips and tricks for RA to LCX ostial lesions. First, we should cautiously decide the indication for RA to LCX ostial lesions, because there are several reasons to avoid RA to LCX ostial lesions. Before procedures, we should estimate the difficulty of RA to LCX ostial lesions, which is mainly determined by the combination of the bifurcation angle and the severity of stenosis. Thus, the combination of the large bifurcation angle and the tight stenosis makes RA to LCX ostial lesions most difficult. Appropriate position of guide catheter and RotaWire is a key to successful RA to LCX ostial lesions. Differential cutting is an essential concept for RA to LCX ostial lesions. However, since there is no guarantee that differential cutting always works, small burr (≤ 1.5 mm) would be a safe choice as initial burr for RA to LCX ostial lesions.
旋磨术（RA）治疗左回旋支（LCX）开口病变可能导致严重并发症，包括血管穿孔。事实上，如果穿孔发生在 LCX 开口周围，挽救性介入治疗（包括植入覆盖支架）可能会导致左前降支区域的致命性缺血，从而导致广泛的前壁急性心肌梗死和随后的死亡。在这篇综述文章中，我们描述了 RA 治疗 LCX 开口病变的技巧。首先，我们应该谨慎决定 RA 治疗 LCX 开口病变的适应证，因为有几个原因需要避免 RA 治疗 LCX 开口病变。在介入治疗前，我们应该评估 RA 治疗 LCX 开口病变的难度，这主要取决于分叉角度和狭窄程度的组合。因此，大分叉角度和严重狭窄的组合使 RA 治疗 LCX 开口病变变得最为困难。导引导管和 RotaWire 的适当位置是成功 RA 治疗 LCX 开口病变的关键。差异化切割是 RA 治疗 LCX 开口病变的一个重要概念。然而，由于不能保证差异化切割总是有效，因此对于 RA 治疗 LCX 开口病变，小磨头（≤1.5mm）作为初始磨头是一种安全的选择。
