Distal Embolization of Calcified Atherosclerotic Plaque Fragment Resulting in “Balloon Uncrossable Lesion” during Elective Percutaneous Coronary Intervention

Abstract

Distal embolization during coronary intervention of thrombotic material resulting in compromised coronary flow is a common complication usually described in the context of invasive treatment of the acute ST-segment elevation myocardial infarction (STEMI). In our case we report distal embolization, presumably with calcified atherosclerotic plaque fragment. It occurred during elective percutaneous coronary intervention on subostial part of right coronary artery. Fortunately, this embolization did not compromise distal flow but it resulted in a significant de novo lesion of the right coronary artery crux. This lesion was uncrossable for dilatation balloons using a variety of different basic and advanced tools and techniques. Therefore, we decided to perform rotational atherectomy that enabled a successful percutaneous coronary intervention with stent implantation.

Keywords

• PCI (percutaneous coronary intervention)
• Distal embolization
• Calcium
• Atherosclerotic plaque
• Balloon uncrossable lesion
• rotational atherectomy