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Rotational Atherectomy first for a very severe calcified lesion and what next
- RA should be indicated first for very severe calcified lesions and performed by experienced interventional cardiology team.
- Be careful when escalating with bigger balloons or burrs for a dissected lesion with significant residual stenosis in between.
- Make sure the rota-wire still good enough and stay in good position and not trapped in dissected calcified lesion before continuing RA.
- IVUS to guide stenting for optimizing the results.