Slides Coronary

Diffuse Heavy Calcified Lesion of RCA Treated by Rotablation

- Operator : Seung-Jung Park

Diffuse Heavy Calcified Lesion of RCA Treated by Rotablation
- Operator: Seung-Jung Park, MD
Case Presentation
A 66-year-old male patient was admitted for further evaluation of thallium-SPECT abnormality for the regular surveillance after PCI. He underwent PCI at the LAD and RCA 11 years ago. The SPECT showed reversible large sized perfusion defect in anterolateral and inferolateral wall. His coronary angiography demonstrated patent previous coronary artery stents, but significant stenosis at the RCA with diffuse heavy calcification in the setting of the RCA dominant coronary system.
His coronary arterial risk factor was hypertension. The physical examination and electrocardiogram were unremarkable. Echocardiography revealed moderate left ventricular systolic dysfunction with akinesia of posterolateral and mid anterior wall.
Baseline Coronary Angiogram
  1. The right coronary angiogram showed patent previous stent at distal RCA but diffuse stenosis at proximal to mid RCA with heavy calcification. ( Movie 1, Movie 2)
  2. The left coronary angiogram showed patent previous stent at proximal to mid LAD. Total occlusion of diagonal artery is identified but no interval change compared with previous angiography. ( Movie 3, Movie 4)
Procedure
An 8 Fr long sheath was inserted through the right femoral artery and right coronary artery was engaged with an 8 Fr AL 1 guiding catheter. The wire, 0.014-inch NEO`(Fielder XT-R) wire was inserted into the RCA with the help of Corsair micro-catheter and Guide zilla 6 Fr guid extension catheter. We decided to perform rotablation for heavily calcified stenotic lesion. A 0.014 inch Rotawire was inserted through corsair micro-catheter and stepwise rotablation was done with 1.5 mm burr. ( Movie 5) While rotablation, atropine was injected and temporary pacemaker was inserted because the patient developed hypotension and bradycardia. After rotablation, we changed a 0.014 inch Rotawire into a 0.014 inch BMW wire and pre-dilatation at mRCA was performed with a Sapphire NC 3.0 x 15 mm balloon. ( Movie 6) After pre-dilatation, we deployed a Xience Alpine stent 4.0 x 38 mm at the mLAD. ( Movie 7) Post-stenting adjunctive balloon dilatation with a Sapphire NC 4.0 x10 mm balloon was done. ( Movie 8) Then RCA was evaluated by IVUS. The final angiogram showed successful results of the procedure. ( Movie 9, Movie 10)

Appendix
LAD IVUS image of post-rotablation ( Movie 11), post-stent ( Movie 12), and final image ( Movie 13)

Comments

  • Bing Liu 2018-12-17 Nice case but so many wrong testes in the case summary

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