Rotational atherectomy in a dire situation: a case report.

Rotablation in presence of dissection can lead to entrapment of the flap in the rotating burr leading to progression of dissection distally or sometimes there can be subintimal tracking of burr leading to perforation. In thrombotic lesions, rotablation can cause further increase in platelet activation and aggregation by the spinning burr or distal embolization of the thrombotic material promoting slow or no flow. In this unusual case with limited options for achieving successful revascularization, some out of the box steps were taken with all recommended precautions and successful outcome achieved.