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We report the case of a patient with acute anterolateral myocardial infarction without ST segment elevations and incipient cardiogenic shock due to complex high grade left main (LM) stenosis and tight calcified ostial left anterior descending (LAD) artery stenosis. Rotablation followed by stent deployment achieved a successful angiographic outcome with no associated clinical complications. During 30 days follow-up, the patient remains stable. An acute interventional approach in unprotected LM coronary stenosis is associated with high procedural risk. Combining that procedure, i.e., rotational atherectomy, with stent placement enhanced procedural success and clinical outcome in this case.

Fig. 1 – Schema of the loop of the diagnostic catheter and procedures for its removal. Case report: A 76-year-old female presented with a history of intermittent chest pain at rest during the previous two days. She had no significant past medical history and was on no medication. Chest X-ray was unremarkable, but her 12-lead electrocardiogram revealed lateral ST depressions of 2 mm. Coronary angiography was performed via her right radial artery. The radial artery puncture was straightforward, and a TIG 5F catheter was used to attempt left coronary angiography. Unfortunately, while struggling to pass through the severe tortuosity of the brachiocephalic artery, the catheter made a loop high in the radial artery close to the brachial bifurcation. Despite gentle attempts to rotate the catheter to undo the kinking, the catheter became stuck in the artery due to spasm, and even gentle manipulation was very painful for the patient. A cocktail of nitroglycerin and verapamil was repeatedly administered intra-arterially, and this relieved the spasm. We were unable to cross through the kinked portion, even with a coronary guide wire. An attempt was made to snare the tip of the catheter with the coronary loop via the right femoral artery and straighten the catheter. This was unsuccessful due to the severe tortuosity of the brachiocephalic artery. We considered vascular surgery to remove the catheter. Prior to going to the surgical department, however, we decided to make one last attempt to straighten the catheter. We cut off the end of the catheter, removed the 6F