Case

Heavily Calcified Lesion Treated by Using Rotablation

- Operator : Michael S. Lee

Heavily Calcified Lesion Treated by Using Rotablation
- Operator: Michael S. Lee, MD
Case Presentation
A 76-year-old male was visited hospital for effort-related chest pain and failed PCI attempt from other hospital. He has medical history of hypertension and dyslipidemia. Physical examination, simple chest radiograph, electrocardiography were unremarkable. Echocardiogram showed normal left ventricular systolic function with regional wall motion abnormality at RCA territory. He received PCI at pmLAD using synergy 3.5 x 28 mm and 3.0 x 28 mm 2 days ago.
Baseline Coronary Angiogram & IVUS
  1. The left coronary angiogram showed diffuse severe stenosis and heavy calcification at proximal to mid LAD with positive FFR (0.75) and normal-looking LCX ( Movie 1, Movie 2, Movie 3).
  2. The right coronary angiogram showed tubular severe stenosis at mid RCA with heavy calcium chunk ( Movie 4).
Procedure
An 7 Fr long sheath was inserted through the right femoral artery and right coronary artery was engaged with an 7 Fr JR 4.0 guiding catheter. 0.014-inch BMW 190 cm wires were inserted into RCA using finecross microcatheter. Rotablation using rotablator 1.5 burr with 153,000 rpm was done at calcified nodules at mid RCA. Subsequent rotablation using rotablator 1.75 burr with 137,00 rpm was done at same RCA calcified lesion ( Movie 5). IVUS after rotablation revealed heavily calcified lesion with cracks ( Movie 6). Pre-balloon with Emerge NC 2.0 x 15 mm up to 12 atm (2.0) NC Trek 3.25 x 15 mm up to 12 atm (3.25) was performed with Guidezilla 6Fr extension catheter (Figure 1). Xience Sierra stent sized 4.0 x 18 mm was deployed at the mRCA ( Movie 7). Post-ballooning with Sapphire NC 4.0 x 10 mm up to 20 atm (4.27) was carried out. Final angiogram showed successful results ( Movie 8).

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