Rotational atherectomy of a stent-jailed septal perforator: a good verdict for the prisoner.

A 61-year-old man is described, in whom percutaneous coronary intervention was done to treat critical ostial stenosis of the first and second septal perforators. The first branch originated from the stented portion of a previously treated left anterior descending artery, while the second branch was distal to the stent. During balloon angioplasty, the balloon catheter could not be delivered to the lesion site in the first branch, although the second branch was easily amenable to balloon dilatation. Rotational atherectomy was done to treat the former. Besides advocating rotational atherectomy as a novel strategy for managing jailed septal perforators, the case presents an insight into the vastly differing interventional situations of stent-jailed branch vis-a-vis de novo branch ostial stenosis.