Guide Tip Damage Due to Rotablation

Figures

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  Figure 1. Coronary Angiography of the Right Coronary Artery (A) Before percutaneous coronary intervention (PCI). The lesion was at the ostium of the right coronary artery (red arrow). A near contrast shot was taken because the 4-F diagnostic catheter was wedged into the coronary artery. (B) After PCI. The lesion was well dilated (red arrow). There was no vessel rupture or delay in blood flow. A temporary pacemaker was placed in the right ventricle.

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  Figure 2. Thin-Slice Computed Tomography Image (A) The arrow indicates the thick calcified lesion at the ceiling of the right coronary artery ostium. (B) A short-axis view of the lesion shows a slit-like lumen wedged between calcified plaques.

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  Figure 3. Intravascular Ultrasonography Images (A) Intravascular ultrasonography (IVUS) showed a nodular calcification on the upper side of the right coronary artery (RCA) ostium (arrowheads) and compression of the lumen by the plaque. (B) After the rotablation with a 2-mm burr, a considerable number of calcified nodules remained (arrowheads), although the lumen had widened partially (arrows). (C) After rotablation with a 2.25-mm burr, the calcified lesion in the RCA ostium was relatively evenly shaved (red arrows). (D) After the percutaneous coronary intervention, adequate dilation of the lesion was confirmed by IVUS.

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  Figure 4. The Damaged Tip of the Guide Approximately a quarter of the circumference of the tip was damaged after percutaneous coronary intervention.

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  Figure 5. The Forces Applied to the Tip of the Guide (A) Right anterior oblique cranial view obtained by fluoroscopy showing the position of the guide, rota burr, and right coronary artery (RCA) (dashed line). (B) Schematic showing the sum and direction of the forces applied to the guide. The net force likely resulted in the burr being pressed against the upper side of the tip of the guide (yellow damage mark).

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  Figure 6. Comparison of Sizes of the Burr and the Guide (A) The sizes of the 2.25-mm rota burr and the inner and outer diameters of the 8-F guide were compared. There was almost no difference between the size of the rota burr and the inner diameter of the guide. (B) The burr tended to get stuck, leading to pressure on the tip of the guide because of the slightly oblique relationship between the guide and the burr.

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  Figure 7. Disengaging the Guide Outside of the RCA Ostium The guide was dislodged from the RCA, and the burr platform was placed out of the guide to prevent damage to the tip of the guide. RCA = right coronary artery.