Case 252: Manual of CTO PCI - Rota-Tripsy for a heavily calcified CTO

A patient presented with exertional dyspnea due to a RCA CTO and a mid LAD lesion. He underwent an unsuccessful attempt for RCA CTO recanalization and was referred for a 2nd attempt. He had a mid RCA CTO with heavy calcification, clear proximal cap, short length of ~10 mm, diffusely diseased distal vessel and a PDA filling via an epicardial collateral through the diagonal branch. Antegrade wiring with a Gladius Mongo resulted in extraplaque crossing. The epicardial collateral was successfully crossed with a Suoh 03 guidewire, but the Caravel microcatheter could not cross. The retrograde wire was used as marker (“just marker” technique) for the antegrade wire. A Gaia Next 2 successfully crossed into the distal true lumen. Delivery of a 1.5 mm burr through the Trapliner failed and resulted in rupture of the Trapliner balloon. After removal of the Trapliner multiple runs of rotational atherectomy were performed. The vessel remained balloon undilatable, hence intravascular lithotripsy was performed with good expansion. After RCA stenting a nice final result was achieved.