Lots of interesting abstracts and cases were submitted for TCTAP 2025. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-034
Breaking Bad: Calcium Modification in an Anomalous Tortuous Right Coronary Artery
By Debdattta Bhattacharyya, Ayan Kar, Snehil Goswami
Presenter
Ayan Kar
Authors
Debdattta Bhattacharyya1, Ayan Kar1, Snehil Goswami2
Affiliation
Narayana Health Rabindranath Tagore Hospital, India1, MMI Narayana Multispeciality Hospital, India2,
View Study Report
TCTAP C-034
Coronary - Adjunctive Procedures (Thrombectomy, Atherectomy, Special Balloons)
Breaking Bad: Calcium Modification in an Anomalous Tortuous Right Coronary Artery
Debdattta Bhattacharyya1, Ayan Kar1, Snehil Goswami2
Narayana Health Rabindranath Tagore Hospital, India1, MMI Narayana Multispeciality Hospital, India2,
Clinical Information
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
58 year old elderly hypertensive female presents with exertional angina NYHA class III since last 2 weeks.She is non-diabetic and has no significant habits .However she has a strong family history of premature coronary artery disease
Relevant Test Results Prior to Catheterization
ECG : suggestive of IWMI of some duration±Echo shows no regional wall motional abnormality with an EF of 70%±Hemoglobin : 10.8g/dl±Creatinine : 1.2 mg /dl±LDL 135 HDL 35 TGL 335
Relevant Catheterization Findings
LMCA : normal LAD : minor disease in the mid part LCX non dominant and free from significant disease RCA : dominant long segment calcium with 2 discrete tandem lesion with a maximum diameter stenosis if 80-90% each
Interventional Management
Procedural Step
RCA engaged with a 7F AL1 catheter. The LAD was wired with the rota floppy wire. Rotablation was done with a 1.5 burr @ 1,20,000 rpm with multiple polishing runs .Post Rota there was no major dissection or slow flow. IVUS done post rota showed 270 degree arcs of calcium with intimal and medial extension. Following this the lesion was aggressively predilated with a 3.5 x15 NC balloon upto 20 atmospheres, showing good luminal gain .2 stents were deployed simultaneously -4x48DES in the prox mid RCA and a 4.5x16 DES in the ostio-proximal RCA in an overlapping fashion .This was followed by post dilatation with a 4x15 NC @ 16 atm and a 4.5 x 15 NC at 14 atm sequentially .Final IVUS showed good apposition of the stent to the vessel wall and no evidence of edge dissections.
Case Summary
Anomalous origin RCA often present with significant calcific disease .using rotational atherectomy mandates explicit planning of such cases .To maintain good catheter support and coaxiality using catheter like the Amplatz is very helpful to deliver such devices across calcific lesions . However, once rotational atherectomy is successful, the lumen gain is significant and lesion preparation becomes easier with sequential non-complaint balloon.It also facilitates DES delivery and optimal expansion with guaranteed better long term outcomes.Additional use of intravascular ultrasound helps in better stent sizing and assess lesion morphology and optimize results further