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Aortic plaque dehiscence caused by rotational atherectomy with Kokeshi phenomenon in a patient with aortic stenosis successfully treated with transcatheter aortic valve replacement
  1. Syedah Aleena Haider1,2,
  2. Anas Jawaid3,
  3. Thomas Stuver4 and
  4. Syed Yaseen Naqvi5
  1. 1Cardiology, Hywel Dda University Health Board, Llanelli, UK
  2. 2Department of Preventive Cardiology, National University of Ireland, Galway, Galway, Ireland
  3. 3Cardiology, Strong Memorial Hospital, Rochester, New York, USA
  4. 4Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
  5. 5Cardiology, St James's University Hospital, Dublin, Ireland
  1. Correspondence to Dr Syedah Aleena Haider; ahaider93{at}


Rotational atherectomy (RA) is an important interventional technique to facilitate effective percutaneous coronary intervention of severely calcified lesions. Despite the improved probability of better procedural outcomes during angioplasty, the use of RA is associated with an inherent risk of complications. Here, we present a case of a woman in her mid-90s with severe aortic stenosis (AS) who underwent RA facilitated angioplasty of the right coronary artery (RCA), with the procedure complicated by the Kokeshi phenomenon. Manual traction to retrieve the burr resulted in dehiscence of an aortic plaque near the ostium of the RCA. Unfortunately, the patient’s risk profile precluded surgery. After a multidisciplinary discussion, a self-expanding Core Valve Evolut R prosthesis (Medtronic, Minneapolis, Minnesota, USA) was successfully implanted, with improvement in the AS and stabilisation of the aortic plaque. This is the first reported case of successful non-operative management of a mobile-aortic plaque caused by RA with a transcatheter prosthesis.

  • Interventional cardiology
  • Cardiothoracic surgery

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  • Contributors SAH and AJ wrote the case report. TS and SYN were the physicians responsible for the patient’s care.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.