Diffuse Long Heavy Calcified Lesion Treated by Rotablation

- Operator : Antonio Colombo

Diffuse Long Heavy Calcified Lesion Treated by Rotablation
- Operators: Antonio Colombo, MD, Yean-Teng Lim, MD
Case Presentation
A 66 year-old woman was admitted with effort chest pain for about one year. Her coronary risk factors were diabetes and hypertension. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. Initial coronary angiography revealed diffuse tight stenosis at pmLAD and mRCA. At first, we performed PCI with a Xience Prime stent (3.5x38mm) at mRCA. Syntax score was 25.
Baseline coronary angiography
The left coronary angiogram showed diffuse tight stenosis at pmLAD with heavy calcifications ( Movie 1, Movie 2).
Procedure
A 7 Fr EBU 3.5 guiding catheter with side hole was engaged into left coronary artery ostium through right femoral approach. A 0.014 inch Rotawire was placed into the LAD. And then, rotablation was performed with a rotablator 1.5mm burr (Figure 1). After rotablation, we changed into a 0.014 inch BMW wire at LAD using FINECROSS microcatheter. Another two 0.014 inch BMW wires were inserted into D1 and D2 branches, respectively. Predilatation at pmLAD with a Voyager NC balloon 2.5x20mm was performed (Figure 2). After predilatation, they deployed the Promus Element stent 2.5x38mm at mLAD (Figure 3) and Promus Element 3.0x24mm at pmLAD. Post-stenting adjunctive balloon dilatation with a Dura Star balloon 3.0x20mm was performed (Figure 4). Final angiogram showed that the procedure was successful ( Movie 3).

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