Slides Coronary

Heavily Calcified Long RCA Lesion Treated Using Rotational Atherectomy

- Operator : Duk-Woo Park

Heavily Calcified Long RCA Lesion Treated Using Rotational Atherectomy
- Operator: Duk-Woo Park, MD
Case Presentation
A 73-year old lady was admitted to our center for evaluation of effort chest pain. She has been on hemodialysis due to end-stage renal disease. Ten years ago, she underwent coronary artery bypass surgery (Lima to LAD, transverse graft to OM). Effort chest pain was recurred one month ago. The echocardiography showed near normal LV systolic function (EF=53%) without RWMA. The coronary angiogram demonstrated subtotal occlusion of proximal to distal RCA with heavy calcification, subtotal occlusion of native proximal LAD and OM with patent LIMA to LAD and OM grafts. Her coronary risk factors were hypertension, diabetes mellitus, and ex-smoking.
Baseline Coronary Angiogram
  1. The left coronary angiogram showed subtotal occlusion of proximal LAD and OM. ( Movie 1, Movie 2)
  2. Coronary bypass grafts were patent. ( Movie 3)
  3. The right coronary angiogram showed diffuse subtotal occlusion of RCA with heavy calcification ( Movie 4).
Procedure
A 6 Fr JR3.5 guiding catheter with side hole was engaged into right coronary artery through right femoral approach. A 0.014 inch SION blue wire placed into the distal RCA under the support of Finecross micro-catheter. However, after the wire placement, two types 1.0 size balloon and even micro-catheter itself cannot pass the mid-RCA culprit lesion (Figure 1). Therefore, we decided to use rotational atherectomy at mid-RCA. We exchanged into a 0.014 inch 325cm Rota wire and performed rotational atherectomy with a 1.5-mm burr for two times ( Movie 5, Movie 6). After Rota ablation, we exchanged Rota wire for longer 0.014 inch Powerturn wire (300 cm) and RCA was dilated with 1.2 X 12mm Emerge balloon, Amadeus 2.5 X 15mm balloon, and Sapphire NC 3.0 X 15mm balloon, subsequently (Figure 2). Then, we deployed three Promus premier (Synergy) stent (2.75 X 38, 3.5 X 38, and 3.5 X 16mm) from proximal to distal RCA (Figure 3). Final angiogram showed that the procedure was successful ( Movie 7).

Comments

  • Santoso Adhiwana 2016-06-17 Good job! You have really a good sense of calculating the RCA-size. Congrats. Dr.med. Santoso Adhiwana
  • Sumiya Tserendavaa 2016-06-20 Good job. Do you use IVUS at RCA.
  • Se Hun Kang 2016-06-20 Thank you for comment. Even the micro-catheter could not pass the calcified lesion of RCA, IVUS assessment was not possible. We decided burr sized on angiographic imaging

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