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Fracture of coronary guidewire during rotational atherectomy with coronary perforation and tamponade.

We present the case of a calcified right coronary artery lesion with a 90-degree exit angle. Attempts at rotational atherectomy led to wire transection and vessel wall perforation necessitating emergent pericardiocentesis and bypass surgery. We review the literature on complications of rotational atherectomy and the management of coronary perforations and retained guidewire fragments.