Successful rotational atherectomy of left main stem with double kiss crush stenting using double guiding catheter: a case report

Background Coronary artery bypass grafting (CABG) is the preferred revascularization procedure for patients with multivessel disease, and those with complex left main disease, as it is associated with a survival advantage in this group of patients. Sometimes however surgical management is not the treatment of choice due to many factors including; ongoing chest pain, hemodynamic instability or patient preference. In these situations, PCI offers an alternative revascularization strategy. In this case study, we present a successful PCI with rotational atherectomy (RA) for distal LMS, LAD and CX using a double guide catheter technique in a patient with severe calcific disease. Case Summery A 63-year-old female was diagnosed with a non-ST elevation myocardial infarction (NSTEMI). Coronary angiography showed significant distal left main stem disease with a severe proximal/ostial calcified lesion of the LAD and a possible thrombotic lesion at the ostium of the CX. She had ongoing hemodynamic instability with chest pain however could not be offered immediate surgical revascularization. We therefore elected to proceed to complex bifurcation LMS coronary intervention using RA under IVUS guidance achieving an excellent final result with TIMI III flow. Discussion This case demonstrates that rotational atherectomy (RA) using the double catheter technique (also known as Ping-Pong) can be safely performed with minimal complication rates and with very favorable angiographic and IVUS results. The clinical outcome was excellent with early discharge.