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Case Reports
. 2020 Sep 23;4(5):1-5.
doi: 10.1093/ehjcr/ytaa298. eCollection 2020 Oct.

Rotational atherectomy through a coronary artery bypass graft after transcatheter aortic valve implantation: a case report

Edgar Illescas  1 , Thomas Cuisset  1 , Jean-Charles Spychaj  1 , Pierre Deharo  1
Affiliations
Case Reports

Rotational atherectomy through a coronary artery bypass graft after transcatheter aortic valve implantation: a case report

Edgar Illescas et al. Eur Heart J Case Rep. .

Abstract

Background: Aortic stenosis (AS) in the elderly is frequently associated with complex coronary artery disease. Rotational atherectomy (RA) in this clinical setting is challenging because coronary slow flow could lead to haemodynamic instability aggravated by the severe AS.

Case summary: We present the case of an 83-year-old woman with symptomatic severe AS, mildly decreased left ventricular ejection fraction and history of coronary artery bypass grafting with right internal mammary artery (RIMA) to the right coronary artery (RCA) and left internal mammary artery to the left anterior descending artery and further percutaneous coronary intervention (PCI) to the circumflex. First, we performed a transcatheter aortic valve implantation (TAVI) to treat the severe AS. Because of persistent symptoms despite good result, we then performed RA of the native RCA through the RIMA with a Guidezilla® guide extension catheter.

Discussion: A two-staged procedure of TAVI and PCI with RA of the RCA via RIMA was successfully performed. We decided to perform the PCI after the TAVI to allow a better haemodynamic tolerance of the complex coronary intervention. This procedure needs caution as the conduit is fragile and could be easily damaged during the RA. No data are available about feasibility and safety of RA through a native graft, but this could be a first step to consider it.

Keywords: Case report; Percutaneous coronary intervention; Rotational atherectomy; Transcatheter aortic valve replacement.

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Figures

Figure 1
Figure 1
(A) Right coronary artery chronically occluded. (B) Left system with chronically occluded left anterior descending. (C) Right internal mammary artery to right coronary artery patent with severe calcified disease beyond anastomosis. (D) Left internal mammary artery to left anterior descending patent.
Figure 2
Figure 2
(A) Set up for rotational atherectomy via internal mammary artery: guide extension catheter (Guidezilla®) was taken further distally to the anastomosis of the graft—microcatheter was placed over a coronary wire to allow quick exchange for the Rotawire®. (B) Rotational atherectomy burr was then advanced through the guide extension catheter up to the lesion and atherectomy was then performed.
None
See this image and copyright information in PMC

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