When the RotaWire Crosses but Cannot Advance: Dual‐Lumen Microcatheter–Assisted RotaWire Delivery

RotaWire delivery can be challenging in severely calcified device-uncrossable coronary lesions when conventional wire exchange through a microcatheter is not feasible. We report a 76-year-old man with a severely calcified mid-left anterior descending coronary artery (LAD) lesion in which neither a microcatheter nor a 0.75 mm balloon could cross. A second channel was created using a penetration wire through a dual-lumen microcatheter, allowing direct RotaWire crossing. However, the RotaWire could not be advanced sufficiently into the distal LAD. After intentional proximal pullback of the dual-lumen microcatheter, the microcatheter and RotaWire were held together and advanced as a single unit, enabling adequate distal RotaWire positioning and successful rotational atherectomy. This case highlights a distinct challenge after successful direct RotaWire crossing and demonstrates coupled advancement with a dual-lumen microcatheter as a potential bailout technique when distal RotaWire advancement remains difficult.