Kokeshi phenomenon and coronary perforation with rotational atherectomy while treating heavily calcified coronary artery disease: A case report.

RATIONALE

Coronary artery disease remains a leading cause of morbidity, requiring complex revascularization strategies, especially in patients with heavily calcified lesions. Percutaneous coronary intervention (PCI) is a common treatment, but it carries risks such as coronary artery perforation and the rare Kokeshi phenomenon during rotational atherectomy (RA). This study aims to emphasize the challenges faced in treating heavily calcified coronary lesions, specifically focusing on the rare Kokeshi phenomenon and coronary artery perforation during RA.

PATIENT CONCERNS

We report the case of a man in his 70s with a history of type 2 diabetes mellitus, atrial fibrillation, and chronic obstructive pulmonary disease, who presented with non-ST elevation myocardial infarction.

DIAGNOSES

Coronary angiography showed the culprit lesion to be a heavily calcified right coronary artery disease.

INTERVENTIONS

After an initial unsuccessful PCI attempt due to a balloon uncrossable lesion in the right coronary artery, the patient underwent a complex RA-PCI.

OUTCOMES

The procedure was complicated by the Kokeshi phenomenon, where the rota-burr became stuck in the calcified lesion, and coronary artery perforation occurred. Through innovative management, including the use of covered stents, both complications were successfully resolved, and the patient was discharged in stable condition.

LESSONS

This case highlights the challenges and potential complications in treating heavily calcified coronary lesions with RA-PCI. Successful management requires prompt identification and innovative solutions to mitigate risks and improve outcomes. The patient's condition was stabilized, and the procedure was successful, with full resolution of complications and normalization of cardiac function postprocedure.