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Rotational atherectomy for severe, heavily calcified, undilatable lesion intervention
- Operator : Seung-Jung Park
|Rotational atherectomy for severe, heavily calcified, undilatable lesion intervention|
|- Operator: Seung-Jung Park, MD|
|Relevant clinical history and physical exam|
A 69 year-old gentleman visited our hospital because of recurrent chest pain. He underwent coronary intervention with Driver 3.5x24mm at proximal LAD in another hospital, 1 month ago. After intervention, he suffered from persistent, effort-related angina. So he visited our lab because of secondary opinion. We checked angiograms of procedure which was performed at another hospital, meticulously. His coronary risk factors were hypertension, dyslipidemia, and diabetes.
|Relevant catheterization findings|
Left coronary angiogram showed severe stenosis at previous stented area. The meticulous analysis of image showed unsuccessful, underexpansion of previous stent with severe calcification. (Figure 1, Figure 2, Figure 3).
Lt. JL4 SH 8Fr guiding catheter was used for intervention. After wiring with conventional 0.014 inch wire, firstly we tried to check IVUS. But IVUS catheter was broken because of severe stenosis. We tried again and succeeded. We check IVUS cautiously. IVUS showed relatively large vessel size but heavy, encircling calcification. And there was some stent inapposition and narrow lumen with encircling stent strut due to calcified, un-dilatable lesion. (IVUS Figure 1, IVUS Figure 2)