Conclusion
ST elevation MI, in the setting of advancing age, decompensated
congestive heart failure and renal dysfunction adds to the complexity of
any coronary intervention. Rotational atherectomy for severely calcified
culprit lesions further adds to the existing challenges. Though, when
the procedure is inevitable, through adequate planning and preparation,
involvement of multi-disciplinary expertise and in the hands of
experienced operators, we can significantly improve immediate and
long-term outcomes. Use of bigger burr size, for debulking is helpful in
lesion preparation and will make the lesion yield. Judicious use of
contrast in such cases is helpful in minimising and managing post-op
renal complications. At successful conclusion of such high risk
procedures, we can significantly reduce the morbidity, mortality and
frequent hospitalizations of the patients.