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.