Slides
Severe Calcified LAD Lesion Treated by Rotational Atherectomy
- Operator : Seung-Jung Park
| Severe Calcified LAD Lesion Treated by Rotational Atherectomy |
| - Operator: Seung-Jung Park, MD |
| Case Presentation |
| A 60 year-old man presented with newly developed effort chest pain. He was diagnosed with severe calcified coronary artery disease in another hospital and referred to our hospital for PCI. His coronary risk factors were hypertension and smoking. The echocardiography showed normal left ventricular function without regional wall motion abnormality and thallium scan was not done. |
| Baseline Coronary Angiography |
1. The left coronary angiogram showed severe calcified stenosis at proximal LAD bifurcation ( Movie 1, Movie 2, Movie 3).2. The right coronary angiogram also showed severe calcified stenosis at distal RCA ( Movie 4). |
| Procedure |
| An 8 Fr sheath was inserted through right femoral artery and the left coronary ostium was engaged with an 8Fr XB 3.5 catheter with side hole and a 0.014 inch SION wire was inserted into the LAD. Due to severe calcification, we exchanged into a 0.014 inch 325cm Rota wire and performed rotational atherectomy with a 2-mm burr for two times (Figure 1). After rotational atherectomy, luminal diameter of mid LAD lesion became bigger ( Movie 5). We reinserted a 0.014 inch Choice PT into the LAD and pre-dilated the LAD using a Empira NC 2.75 x 15 mm (Figure 2, Figure 3). We placed a 0.014 inch SION wire into RI branch for protection and deployed a Xience Prime stent 3.0 x 38mm at LAD ostium to mid LAD (Figure 4). Adjunctive post-stenting balloon dilatation was done using Amadeus 3.5 x 15mm and TREK NC 3.5 x 15mm at the LAD (Figure 5, Figure 6). After LAD PCI, we performed balloon angioplasty at distal RCA (Figure 7). Final angiogram showed that the procedure was successful ( Movie 6, Movie 7, Movie 8, Movie 9). |
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