CASE REPORT article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Successful Intravascular Ultrasound–Guided Percutaneous Coronary Intervention of a Single Coronary Artery With Chronic Total Occlusion and Severe Calcification Using Rotational Atherectomy
Kun Chen
Ning Guo
Changde Hospital, Xiangya School of Medicine, Central South University（The first people’s hospital of Changde city), Changde, China
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Abstract
An isolated single coronary artery (SCA) is an uncommon congenital anomaly with an incidence of approximately 0.024%. The coexistence of chronic total occlusion (CTO) and severe calcification in a patient with SCA poses substantial procedural challenges during percutaneous coronary intervention (PCI). We report the case of a 52-year-old man with an anomalous right coronary artery (RCA) arising from the left main trunk (LMT), accompanied by proximal RCA CTO, heavily calcified left anterior descending (LAD) artery, and subtotal occlusion of the left circumflex (LCX) artery. Coronary artery bypass grafting (CABG) was declined, and staged PCI was performed under intravascular ultrasound (IVUS) guidance. The first procedure involved LCX stenting and successful RCA CTO recanalization. The second procedure included rotational atherectomy (RA) of the LAD, stenting from the LMT to LAD. Final complete revascularization was achieved, and IVUS imaging confirmed optimal stent expansion. This rare case illustrates that staged, IVUS-guided PCI can be performed safely and effectively in patients with SCA and complex multivessel disease, and that RA is a feasible and safe option for managing severe calcification in this unique anatomical setting.
Summary
Keywords
chronic total occlusion, Coronary calcification, Intravascular ultrasound, Percutaneous Coronary Intervention, Rotational atherectomy, Single coronary artery
Received
08 November 2025
Accepted
11 February 2026
Copyright
© 2026 Chen and Guo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Ning Guo
Disclaimer
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