Complex PCI to Calcific LAD Stenosis

Operators:Doç. Dr. Mutlu Vural

Bağcılar Education and Research Hospital


65 year old type 2 diabetic and hypertensive male patient is ex-smoker. His cretinine level is 1.3 mg / dl followed by nephrology department. Because the patients has calcific RCA and LAD stenosis, coronary bypass surgery was recommended in another center due to intense calcification in the coronary arteries.


The patient applied to our center because he did not want to undergo bypass surgery and was hospitalized for a complex PCI procedure. The floppy wire was escalated through the RCA stenosis (Video 01). Predilatation is achieved at16 atm by 2.75 x 15 NC balloon. After 3.0 × 32 mm DES deployment, postdilatation was performed with 3.5 × 12 NC balloon at 20 atm. A satisfactory result was obtained (Video 02). Because the creatinine value was high, the LAD procedure was left for the next session.


Two weeks later, an appointment was made for stiff LAD stenosis. A 7F left (AL-2, JL4.0) guide catheters was introduced to LM. A guidewire was introduced to a calcified LAD stenosis and another floppy wire to the diagonal (Video 03). A 2.75 × 15 mm sprinter NC balloon was able to break the lesion at 18 atm distal to diagonal in the LAD (Video 04). Then the balloon was drawn to the diagonal level (Video 05). The balloon was gradually dilated up to 28 ATMs, but the hourglass appearance was observed (Video 06). The cutting balloon did not pass the lesion though the anchor at 10 atm with 3.5 × 15 balloon in LCX. Success was not achieved with the new NC balloon by parallel wires. LAD was dissected, but the flow was good and the patient followed in intensive care unite(Video 07). The patient was reprocessed with the support of rotablater. It is difficult to pass floppy wire from LAD dissection (Video 08). The dissection was contraindicated for the ratablator. That’s why we passed the LAD’s with a PT-2 guidewire carefully to ensure that we do not go subintimally when crossing the lesion. Before we exchanged Rotawire through Corsair, we checked that we were in the lumen (Video 09). After the 1.5 burr rotablation 2 minutes pre-diagonal region (Video 10), NC balloon 26 atm appeared the same image. Three more minutes of resistant zone-oriented rotablation was applied. The lesion was then broken withsame NC balloon at 16 atm. Later, 2.5 × 38 and 3.0 × 18 Xience stents were placed (Video 11, Video 12). After, POT with 2.75 × 15 and 3.0 × 12 NC balloons were performed. The result was satisfactory (Video 13, Video 14).

There was no reversal of symptoms that improved after five months.

Video 01

Video 02

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Video 13

Video 14

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