Rotablation Wire Fracture During a Challenging Percutaneous Coronary Intervention

Rotablation is considered a standard plaque-modification procedure in the treatment of calcified coronary lesions. The rotablation coronary wire is specifically designed to endure the high pressures and temperatures developed during rotablation. This is a case report of a severely calcified proximal right coronary artery coronary lesion rotablation. Several runs were successfully performed at the lesion; however, during the final run, the rotablation wire was severed and entrapped at the lesion site. It was snared and partially retrieved out of the vessel. The intravascular ultrasound-guided percutaneous coronary intervention was completed successfully. Only 2 other reported cases of rotablation wire fracture exist. Despite the specific design of the rotablation wire, several factors (eg, heavy calcification, difficult anatomy, and "wire fatigue") seem to have caused this unusual complication. Even specifically designed, "unbreakable" wires may sometimes break. Usually complex cases do not go as planned, so the operator needs to "improvise, adjust, and overcome."