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CASE20191104_001
| CORONARY - Adjunctive Procedures (thrombectomy, atherectomy, special balloons) | |
| Left Anterior Descending Coronary Artery Calcification Lesion Treated by Rotational Atherectomy | |
| Qing Yang1, Chengcheng Wu2 | |
| Beijing Anzhen Hospital, China1, Tianjin Medical University General Hospital, China2, | |
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[Clinical Information]
- Patient initials or identifier number:
LHF
-Relevant clinical history and physical exam:
The patient was a 66-year-old woman. She was hospitalized due to chest pain for 10 years and aggravation for 1 week.1 week before admission, doctors from other hospital performed LAD PCI. Due to severe calcification, LAD occlusion occurred after balloon dilation. Her coronary risk factors were hypertension and hyperlipidemia and history of cerebrovascular accidents. The baseline ECG and cardiac markers were abnormal.
-Relevant test results prior to catheterization:
ECG showed ST segment depression on V2-V6 lead. The echo showed that LVEF was 0.42,left ventricular anterior wall motion was weakened.
- Relevant catheterization findings:
CAG showed: LM was narrowedby 50% and the plaque was ruptured, LAD was subtotal occlusion with calcification, LCX was small, no stenosis, and RCA stenosis was 80-90%.
 LAO+CAU.avi RAO+CRA.avi LAO.avi |
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[Interventional Management]
- Procedural step:
An 6F sheath was inserted through right radial artery. CAGshowed: LM was narrowed by 50% and the plaque was ruptured, LAD was subtotal occlusion with calcification, LCX was small, no stenosis, and RCA stenosis was80-90%.The left coronary artery was engaged with an 6F EBU 3.5 catheter. The 0.014-inch 180cm Runthrough NS wire was inserted into the LAD. With the help of IABP, we performed coronary atherectomy on the LAD(1.25mm+1.5mm Rota), and then LAD were dilated with 2.0¡¿15mm Quantum balloon, 2.5¡¿15mm Quantum balloon. Premier 2.25 X 28 mm stent was successfully deployed at middle segment of LAD. Premier 3.0 X 20 mm stent was successfully deployed at proximal segment of LAD. And then a Premier 3.50 X 24 mm stent was successfully deployed at LM to proximal LAD. Final CAG and IVUS showed that the procedure was successful.
ROTA1.avi ROTA2.avi PCI.avi- Case Summary:
Use of IVUS should be actively considered for complex PCI. Hemodynamic support for high-risk PCI is very important. Rotational atherectomy is required for severely calcified esions. At last, the revascularization is successfully completed. |
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