Potent Stent-Less Procedure Using Rotational Atherectomy and Drug-Coated Balloon to Right Coronary Ostial Lesion
- • Revascularization therapy for de novo calcified RCA ostial lesion remains to be a problem.
- • Revascularization therapy for refractory in-stent restenosis due to calcified nodule remains to be established.
- • Rotational atherectomy followed by drug-coated balloon dilation alone is proposed as a choice.
Even in the drug-eluting stent era, ostial lesion of the right coronary artery (RCA) still remains therapeutic challenge for interventional cardiologists. Case Series Case 1 (76 y.o. male) with angina on effort underwent transradial stent-less percutaneous coronary intervention (PCI) using rotational atherectomy (RA) followed by drug-coated balloon (DCB) dilation alone (RA/DCB) against a calcified de novo RCA ostial lesion. Case 2 (86 y.o. female) with recurrent unstable angina and hemodialysis underwent transfemoral RA/DCB against a severe repeat in-stent restenosis probably due to calcified nodule in the RCA ostium. In the both patients, PCI was successfully completed under intravascular ultrasound imaging (IVUS) guidance without complications. Follow-up CAG performed 4–5 months after the procedure revealed no significant lumen narrowing in the both RCA ostial lesions.
The both cases suggest that stent-less PCI using RA/DCB under IVUS might be an alternative revascularization therapy of choice for calcified RCA ostial lesions.
Cardiovascular Revascularization Medicine, 2019-09-01, Volume 20, Issue 9, Pages 822-826, Copyright © 2018 Elsevier Inc.
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