Transvascular Balloon Occlusion: A Novel Bailout Strategy in Large Left Main Perforations

Several complications have been reported in rotational atherectomy, and these complications are closely associated with cardiac tamponade, emergent surgery, and death. Here we describe a case of left main coronary artery, bullet-like perforation treated with a novel approach-transvascular balloon occlusion. (Level of Difficulty: Advanced.).

Wire Cutting Method Using Rotational Atherectomy for Stretched Spring Wire During Coronary Intervention

During removal of an entrapped guidewire, the core wire can fracture, allowing stretching of the spring wire while the distal guidewire is still entrapped. We resolved this issue with rotational atherectomy, allowing cutting of the spring wire at the intended site, regardless of the proximal spring wire fracture. (Level of Difficulty: Advanced.)

Orbital-Tripsy: Novel Combination of Orbital-Atherectomy and Intravascular-Lithotripsy, in Calcified Coronaries After Failed Intravascular-Lithotripsy

Calcified coronary lesions are notorious for posing technical difficulty during angioplasty. Fortunately, more devices are available to tackle coronary calcifications. However, there remain difficult cases whereby a single modality is insufficient. Here we report the feasibility and success of a case, using Novo combination of Shockwave Lithotripsy after Orbital Atherectomy. (Level of Difficulty: Intermediate.).

Stuck Between a Rock and a Hard Place: Management of an Entrapped Rotablator Burr

Burr entrapment remains a serious complication of rotational atherectomy. This report describes an advanced technique for the management of entrapped atherectomy burrs. Commonly strategies were unsuccessful. A chronic total occlusion angioplasty technique was used successfully: the subintimal dilation and "external crushing" plaque modification technique. (Level of Difficulty: Advanced.).