Fractured Guidewire in Calcified Chronic Total Occlusion: Is Rotational Atherectomy Contraindicated?

Background: Fracture of guidewires may occur during attempts to recanalize severely calcified chronic total occlusions (CTOs) via percutaneous coronary intervention (PCI). When a fractured guidewire becomes entrapped within the lesion, rotational atherectomy (RA) may serve as a safe rescue strategy. Case: We report a case in which RA was utilized both to recanalize the heavily calcified CTO and to simultaneously ablate the entrapped guidewire fragment. Conclusions: RA may serve as a safe rescue strategy to manage the fractured guidewires within CTO segments.