Rotational coronary atherectomy in acute ST-segment elevation myocardial infarction.

The usual large thrombus load encountered in acute ST-elevation myocardial infarctions increases the likelihood for slow-flow or no-reflow during percutaneous coronary intervention. The use of rotational atherectomy in this clinical scenario is usually prohibitive due to the potential for further induction of platelet activation and aggregation by the rotating burr. In this case presentation, primary percutaneous coronary intervention for an acute ST-elevation myocardial infarction was performed. Due to the complex vessel geometry, pretreatment with atherectomy was mandatory with the only available atherectomy device in the laboratory: Rotablator. This case represents the first report on the successful use of rotational coronary atherectomy in the setting of acute ST-elevation myocardial infarction.