A Case of Successful Stenting with Zotalimus-eluting Stent (Endeavor) at Heavily Calcified LAD disease after Rotational Atherectomy: Importance of Guiding Catheter Selection, Lesion Modification and Use of Stent with Good Deliverability

- Operator : Jung Rae Cho

A Case of Successful Stenting with Zotalimus-eluting Stent (Endeavor) at Heavily Calcified LAD disease after Rotational Atherectomy: Importance of Guiding Catheter Selection, Lesion Modification and Use of Stent with Good Deliverability.
- Operator: Jung Rae Cho, MD
Clinical presentation
A 60-years old man was admitted due to effort-related chest pain. His coronary risk factor was hypertension. His past medical history was intracranial hemorrhage of basal ganglia 17 years ago and lacunar infarction 10 years ago.
Baseline coronary angiogram
1. Left coronary angiogram showed diffuse luminal narrowing (up to 90%) with severe calcification at proximal portion of Left anterior descending artery (LAD). (Figure 1, Figure 2)
2. Right coronary angiogram showed diffuse luminal narrowing at mid of right coronary artery (RCA) (Figure 3).
Procedure
In order to get strong back up, a 6Fr XB (Cordis, USA) guiding catheter was used. After 0.014 inch guidewire (Rinato, Asahi, Japan) passage through the lesion, balloon dilation with Maverick 2.0 x 2.0mm (Boston Scientific, USA) was performed at 14atm for 5 seconds. However, balloon ruptured without any dilation (Figure 4, Figure 5, Figure 6). Then, another balloon (Optimo 2.0 x 2.0mm, Kaneka, Japan) was performed at 18atm for 10 seconds, but dilation was minimal (Figure 7, Figure 8, Figure 9). So, rotational atherectomy (Rotablator, Boston Scientific, USA) was performed with 1.5mm-sized burr (Figure 10). Follow up angiogram showed that lesion was dilated than before (Figure 11, Figure 12). Then, Endeavor 3.0 x 24mm (Medtronic, USA) was delivered to the lesion smoothly without either any resistance or guiding catheter instability. The stent was deployed at 16atm for 10 seconds and there was less than 10% residual stenosis after stenting (Figure 13, Figure 14, Figure 15, Figure 16).

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