A 7 Fr sheath was inserted thorough the right femoral artery and right coronary artery was engaged with a 7 Fr JR 4 guiding catheter. The wire, 0.014-inch Sion was inserted into the RCA. Pre-dilatation performed with a Raiden 3 4.0 x 20 mm balloon. ( Movie 3) And then we performed two drug-eluting balloon inflation(Pantera Lux 3.5 x 20 mm) at pRCA ISR lesion. ( Movie 4) Final angiogram showed no residual in-stent narrowing in pRCA stent. ( Movie 5) The left coronary artery was engaged with a 7 Fr JL 4 guiding catheter. The wire, 0.014-inch Sion was inserted into the LAD. Pre-dilatation performed with a Euphora 2.0 x 20 mm balloon ( Movie 6), but it was failed due to calcified lesion. We performed Emerge NC 2.75 x 20 mm for pre-dilatation, but it was failed again. And then we performed Angiosculpt 3.0 x 15 mm inflation for calcified lesion, but it was not effective. Finally we decided to perform rotablation for calcified lesion. The wire, 0.014-inch Sion was inserted to diagonal branch for side branch protection. Then, a 0.014 inch Rotawire was placed into the LAD. Based on IVUS and angiography image, we performed with a rotablator 1.5mm burr and 1.75mm burr. ( Movie 7) We changed a 0.014 inch Rotawire into a 0.014 inch BMW wire at LAD. Pre-dilatation at proximal LAD ISR and mid to distal LAD with Angiosculpt 3.0 x 15 mm and Pantera LEO 3.5 x 20 mm was performed. ( Movie 8) After pre-dilatation, we deployed the Xience Alpine stent 2.5 x 38 mm at mdLAD ( Movie 9) and Xience Alpine stent 3.5 x 18 mm at pmLAD. ( Movie 10) Post-stenting adjunctive balloon dilatation with Emerge NC 2.75 x 20 mm and NC TREK 3.0 x 20 mm. And the we performed drug-eluting balloon inflation(Pantera Lux 3.5 x 30 mm) at pLAD ISR lesion. ( Movie 11) Final angiogram showed that the procedure was successful. ( Movie 12)
Appendix
LAD IVUS image of baseline ( Movie 13), pre-ballooning ( Movie 14), post-rotablation ( Movie 15), and final image ( Movie 16)
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