Tortuous and Calcified Lesion Treated Using Rotablation

- Operator : Seung-Jung Park

Tortuous and Calcified Lesion Treated Using Rotablation

- Operator: Seung-Jung Park, MD

Case Presentation

A 71 years old female patient visited the clinic for effort related chest pain started 6months ago. Her coronary arterial risk factor was diabetes. The physical examination finding and electrocardiogram were unremarkable. Echocardiography revealed normal left ventricular systolic function without regional wall motion abnormality.

Baseline Coronary Angiogram

The Right coronary angiogram showed tortuous vessel with significant stenosis at the proximal RCA with heavy calcification ( Movie 1, Movie 2). The Left coronary angiogram showed diffuse stenosis through the left anterior descending and left circumflex artery with heavy calcification ( Movie 3).

Procedure

A 8 Fr long sheath was inserted through the right femoral artery and right coronary artery was engaged with a 7 Fr JR 4 guiding catheter. The wire, 0.014-inch BMW was inserted into the RCA with the help of Caravel micro-catheter. Because of sinus and junctional bradycardia after wiring, the temporary pacemaker was inserted. We decided to perform rotablation for tortuous and calcified lesion. A 0.014 inch Rotawire was inserted through Caravel micro-catheter and stepwise rotablation was done with 1.25 and 1.5 mm burr ( Movie 4, Movie 5). After rotablation, we changed a 0.014 inch Rotawire into a 0.014 inch BMW wire and pre-dilatation was performed with a Empira NC 4.0 x15 mm balloon ( Movie 6). Pre-dilatation at the mid RCA with Everest 2.5 x 15 mm was also performed with back up by Guidezilla 6Fr extension catheter ( Movie 7). After pre-dilatation, we deployed a Xience Alpine stent 4.0 x 28 mm at the pmRCA ( Movie 8). Post-stenting adjunctive balloon dilatation with a Empira NC 4.0 x15 mm balloon was done ( Movie 9). The final angiogram showed successful results of the procedure ( Movie 10). Appendix LAD IVUS image of post-rotablation ( Movie 11), post-stent ( Movie 12), and final image ( Movie 13)