Life-threatening perforation of the left main coronary artery by a rotablator burr delivered on a broken rotawire

An 80-year-old man had a stenotic lesion with severe calcification in the proximal and mid left anterior descending artery (LAD) (Panel A, yellow arrows). A 7-Fr Amplatz left catheter was inserted, and we performed rotational atherectomy using a 1.25-mm burr to mid LAD. At the time of its removal, the burr in the dynaglide mode slightly stuck to the left main coronary artery (LMCA) (Supplementary material online, Movie S1). For additional atherectomy to the proximal LAD, we delivered a 1.5-mm burr in the dynaglide mode. Surprisingly, the burr shot out of the LMCA wall (Panel B), and blow-out perforation occurred (...