Background: Calcified coronary lesions represent technical challenges during percutaneous
coronary intervention and are associated with a high frequency of restenosis and target lesion
revascularization. Rotational atherectomy has been shown to increase procedural success in severely
calcified lesions, facilitate stent delivery in undilatable lesions and ensure complete stent expansion.
However, rotational atherectomy in ST-elevation Myocardial Infarction (STEMI) is traditionally
avoided given the concern for slow or no reflow and considered a contraindication in lesions
with a visible thrombus by its manufacturer (Rotablator, Boston Scientific).
Conclusion: This case demonstrates the successful use of rotational atherectomy to facilitate dilation
and revascularization of a heavily calcified culprit lesions in a patient with acute anterior
STEMI with ongoing chest pain.
Keywords: Rotational atherectomy, STEMI, calcified culprit lesion, thrombus, chest pain, TLR.
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