Rotational atherectomy to facilitate stent expansion after deployment in ST-segment-elevation myocardial infarction.

We describe successful rotational atherectomy performed in the setting of two relative contraindications to the procedure. A 77- year-old female presented with ST-segment-elevation myocardial infarction due to 100% right coronary artery thrombosis. With high pressure dilatation (22 atmospheres) and cutting balloon angioplasty, the lesion dissected but did not fully dilate. After stenting and high-pressure post-dilatation at 25 atmospheres the dissection resolved, but a 70% waist remained. Rotational atherectomy allowed full dilatation of the lesion at 22 atmospheres. In this case, after stenting removed angiographically evident thrombus and dissection, rotational atherectomy effectively and safely treated residual stenosis at an undilatable lesion.