Diffusely Calcified Long Lesion Treated Using Rotablation

- Operator : Jung-Min Ahn

Diffusely Calcified Long Lesion Treated Using Rotablation
- Operator: Jung-Min Ahn, MD
Case Presentation
A 68 years old male patient was hospitalized for resting chest pain started 6 hours ago. He received proximal LAD and OM branch stenting 17 years ago in other hospital and proximal to mid RCA and distal RCA stenting 2 years ago in our hospital. ECG and cardiac enzyme were unremarkable.
Baseline Coronary Angiogram
  1. Left and coronary angiogram showed significant stenosis at proximal LAD ISR lesion and mid to distal LAD significant stenosis with calcification. ( Movie 1)
  2. The right coronary angiogram showed diffuse stenosis at proximal and distal RCA ISR lesion. ( Movie 2)
Procedure
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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