Sequential rotablation for calcified tandem right coronary artery lesions with guide extension assistance

Calcific coronary artery disease presents a major challenge for percutaneous coronary intervention as it can be associated with stent delivery failure and suboptimal stent expansion. Currently, numerous therapeutic options are available for modifying calcific coronary plaques, and also coronary imaging to assess adequacy of plaque modification. Mechanical debulking with rotational atherectomy is the time trusted plaque modification strategies for heavily calcified and recalcitrant coronary lesions prior to stenting. We report a rare case with calcified tandem right coronary artery lesions in which sequential rotablation done using guide catheter extension to facilitate delivery of rotational atherectomy burr to distal lesion enabling successful percutaneous coronary interventions.