Rotational atherectomy for a heavily calcified and diffuse lesion

- Operator : Seung-Jung Park

Rotational atherectomy for a heavily calcified and diffuse lesion
- Operator: Seung-Jung Park, MD

A 64 year-old female was admitted with progressive effort chest pain over 5 months. She had a history of angina and undergo thallium SPECT showed normal perfusion in 2006. Her ECG showed no ST-T segment change. She was not a smoker and didn¡¯t have a history of diabetes, hypertension or hyperlipidemia.

Baseline coronary angiogram

1. A right angiogram showed mild stenosis of proximal RCA.(Figure 1)
2. A left coronary angiogram showed a calcified and diffuse stenosis of LAD with severe narrowing at the LAD-first diagonal bifurcation.( Movie 1)

Procedure

An 8 Fr JL 3.5 with side-hole guiding catheter was engaged into left coronary artery. The LAD was crossed with 0.014¡± Floppy BMW guidewire and diagonal branch with 0.014¡± Soft guidewire. Firstly, the lesions was dilated with a non-compliant balloon (Dura Star 2.5 * 20 mm) at two times.(Figure 2, Figure 3) Using Finecross 1.8 Fr microcatheter, the wire in LAD was changed to the 325 cm 0.014¡± Rota wire. Rotational atherectomy was performed using 1.5 mm burr followed by a balloon dilatation. The angiogram taken after that procedure showed multiple and significant dissections of the mid LAD with impaired flow distal to the distal largest dissection.( Movie 2) Several balloon dilatations with Dura Star 2.5 * 20 mm were performed and distal flow was improved.(Figure 4, Movie 3) A 2.75 * 28 mm sized Cypher select stent was deployed in the mid LAD and a 3.0 * 33 mm Cypher select stent was deployed in the proximal LAD with overlapping.(Figure 5, Figure 6) After deploying stents, additional balloon dilatations were preformed using non-compliant balloons (Dura Star 2.5 * 20 mm, Dura Star 2.75 * 20 mm, Fortis 3.5 * 18 mm). Final angiogram showed a good result.(Figure 7)

Comments

  • Zhonghan Ni 2010-05-08 upgrading to 1.75mm burr might prevent following dissection which should had resulted from balloon dilataion

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