Retrograde Crossing Facilitating Rotational Atherectomy for Recanalization of Uncrossable Near Aorto-Ostial Chronic Total Occlusion: Case Report

Calcified near aorto-ostial chronic total occlusions pose considerable procedural challenges because of their intricate anatomical configuration. This case concerns a 64-year-old uremic woman with a near-ostial chronic total occlusion of the right coronary artery. Following the failure of retrograde RG3 externalization because of an uncrossable lesion, a staged percutaneous coronary intervention was undertaken, employing rotational atherectomy with a RotaWire Extra Support wire (Boston Scientific) that capitalized on microfractures previously created by antegrade and retrograde 0.014-inch guidewires. This case underscores the strategic utilization of guide wire-induced microfractures to facilitate direct RotaWire advancement and illustrates a safe and effective approach for navigating anatomically complex coronary lesions.