ABSTRACT
The guide catheter is firmly engaged into the coronary artery to provide strong support. Then, the balloon is pushed against the lesion with alternating fine forward and backward movements. Anchoring is performed to allow a balloon to pass through the occlusion with a severe superficial calcification. When use of a Tornus is expected, a Y-connector with a hemostatic valve is attached in advance to ensure good torque transmission and prevent blood loss during its manipulation. The Rotablator is very effective in debulking superficial calcification of balloon-uncrossable Chronic total occlusions (CTO). First, the stiff wire that has crossed the CTO should be exchanged for a Rotafloppy using the ‘bare wire exchange’ method. The wire that has crossed the CTO is left in situ, while another stiff wire is inserted parallel to it and advanced by repeated pushing and pulling so that it is entangled with the first wire and dilates the lumen.
