The DELIVER Technique

The delivery of the rotational atherectomy burr can sometimes be hindered in distal calcified lesions complicated by proximal vessel tortuosity or other obstacles. This problem may result in procedural failure or fatal complications, including coronary perforation, burr entrapment, or driveshaft fracture. To prevent these catastrophic outcomes and ensure successful burr delivery, we introduce the DELIVER (Deep Engagement of guide catheter or 5-F chiLd-guIde catheter for burr deliVEry and subsequent Rotational atherectomy) technique. This method involves deep catheter insertion beyond proximal vessel tortuosity or other obstacles, using strategies such as the distal balloon anchoring technique. Once the catheter is positioned, the rotational atherectomy burr is advanced through it to facilitate the atherectomy of the distal target lesion. This report presents 3 cases where the DELIVER technique was applied successfully to treat distal lesions. The technique enabled smooth and atraumatic burr delivery, even through tortuous arterial segments or other challenging anatomical structures.