ROTA-CUT percutaneous coronary intervention strategy for a balloon-uncrossable lesion in a postcoronary artery bypass graft patient with occluded left internal mammary artery-left anterior descending artery graft

Percutaneous coronary intervention (PCI) of moderate to severely calcified lesions is associated with increased major adverse cardiovascular events (MACEs). Atheroablative strategies facilitate balloon dilatation and stent deployment in calcified lesions. We report a case of a 50-year-old male with postcoronary artery bypass graft status and an occluded left internal mammary artery graft who presented to us with crescendo angina. A coronary angiogram revealed a severely calcified 95% stenosis in the proximal left anterior descending artery with thrombolysis in myocardial infarction II flow. The ROTA-CUT strategy was used in this balloon-uncrossable and balloon-nondilatable lesion to facilitate stent deployment and achieve optimal stent expansion. The ROTA-CUT trial showed the feasibility and safety of ROTA followed by cutting balloon dilatation in these calcified lesions. However, it did not show any difference over ROTA followed by noncompliant balloon dilatation with regard to luminal gain and MACE rates at 9 months. Rotablation is an excellent bailout tool in balloon-uncrossable calcified coronary lesions. ROTA-CUT PCI strategy is safe and feasible in calcified coronary lesions.