Complex PCI for Calcific LAD and Multi-vessel Disease

Operators:Prof.Dr.Şevket Görgülü

Acibadem University, Kocaeli Acıbadem Hospital

Case Summary 

A 61 year-old male patient low EF (%25)  admitted to our hospital with the complaining of dyspnea as angina equivalent for 2 months. Comobidities were total occlusion of the left carotid artery, diabetes and hypertension.

Procedure Explanation

Right radial 6F approach is preferred (Video 01). On coronary angiography, LCX intermedier 90% stenosis (Video 02), heavily calcified LAD with 90% stenosis , (Video 03) RCA middle vessel lesion 90% stenosis were detected (Video 04). Becasuse a 1×20 mm balon could not cross the LAD lesion, the case was postponed for complex PCI at another session. Preperation was done for complex intervention (Video 05) Second session: right radial 7F EBU guiding catheter was placed in the LMCA. At first, the LAD was targeted. Calcification between the two stent is prominent (Video 06). LAD was crossed with a Supercross microcatheter and Fielder FC wire (Video 07). The wire was replaced with the rotablator wire and a 1,5 Burr rotablator was advanced into the LAD (Video 08). Guiding catheter support was problem due to heavy calcification (Video 09). Calcification was cracked down after rota, and floppy 300 wire was replaced the rota wire (Video 10). A 3.0×10 cutting balloon was advanced with the help of a 6F guideliner. This balloon burst during inflation (Video 11). A second 3.0×15 cutting balloon was inflated along the whole lesion territory at maximal atm (Video 12). After predilatation, stent deployment is planned (Video 13). A 3.0×38 Resolute integrity stent was deployed (Video 14). Another 3.0×38 Resolute integrity stent deployed proximal of the first stent (Video 15). LAD after stent placements was well perfused (Video 16). LCX OM crossed with a PT2 wire, 2 mm balloon could not cross the lesion, predilatetaion was done first with a 1.25x15mm balloon (Video 17). Further predilatation with a 2.0×15 balloon (Video 18). Then, a 2.5×18 Resoltue integrity was deployed at 16 atm (Video 19). Final LCX view was satisfactory (Video 20). Next, RCA proximal and PDA distal 95 % lesions were performed  (Video 21). Both proximal and distal lesions were predilated with a 2.0×15 balloon. First, 2.5×22 Resolute integrity was placed at the distal PDA branch (Video 22). The proximal lesion was treated with a 3.0×23 Xience V stent (Video 23) Final angiogram of RCA was satisfactory.

Nurse: Buse Taşdemir
Angio Technician: İsmail Topaç

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Calcifed Lesions