DISLOCATION OF THE ROTATING CUTTER DURING DIRECTIONAL CORONARY ATHERECTOMY - A NOTE OF CAUTION

Directional coronary atherectomy (DCA) has received increased attentio n, especially as a bail-out procedure after failed balloon angioplasty . However, this technique may also be burdened by severe pitfalls. We report a patient with a balloon-resistant left coronary artery lesion subsequently treated with DCA. Despite its over-the-wire guidance, as the rotating cutter was advanced, it deviated from its intra housing c ourse and intruded into the vascular wall. Dislocation of the rotating blade was due to pressure from hard plaque tissue. After having caref ully pulled back the complete catheter system, a severe spasm of the l eft main stem occurred, which was reversed by intracoronary nitroglyce rine. The final angiography showed a left coronary artery without sign ificant, residual stenosis. The case report underscores that DCA passe s must be performed under continous fluoroscopic control, especially f or balloon-resistant lesions because of the unpredictability of DCA-im minent complication. (C) 1995 Wiley-Liss, Inc.