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ABS20191031_0008
Complex and Higher Risk Procedures for Indicated Patients (CHIP)
Carve Your Way - Orbital Atherectomy with Mechanical Circulatory Support in Severely Calcified Lesions
Tsz Ho Chan1, Yu Ho Chan2
Pok Oi Hospital, Hong Kong, China1, The CUHK Medical Centre, Hong Kong, China2
Background:
63 years old gentleman with poor control on diabetes, hypertension, hyperlipidemia, and chronic kidney disease, admitted to hospital because of acute pulmonary edema. He was intubated and transferred to our unit.

Chest X ray showed congestion of lungs. Electrocardiogram showed poor R wave progression and tall T wave in anterior leads. Blood test showed raised creatinine and cardiac enzymes. Echocardiogram showed global hypokinesia and left ventricular ejection fraction less than 35%.

After good diuresis, he was stabilized and underwent diagnostic coronary angiogram.
Methods:
Diagnostic coronary angiogram showed triple vessels disease, heavily calcified, long diffuse disease. Syntax score 1 was 25 while syntax score 2 for PCI was 47.1 (PCI 4 year mortality as 25.7%).
The patient decided to proceed to PCI under mechanical support (Impella). Left circumflex artery (non-culprit lesion) was decided to treat first with balloon angioplasty followed by stenting. Afterwards, left anterior descending artery (culprit lesion) was treated with orbital atherectomy (Diamondback 360) followed by stenting
Results:
Final angiogram showed satisfactory result in vessel size and blood flow.
The patient was discharged afterwards. He did not get any recurrence in chest discomfort and no repeated revascularization is needed until now
Conclusion:
CHIP with PCI done under mechanical support and orbital atherectomy.

Discussion point
- CHIP definition and decision on mechanical assist device before intervention
- Mechanical support choices in CHIP - Impella vs other devices
- Different techniques or devices in tackling heavily calcified lesions - orbital or rotational atherectomy, shockwave
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