Author + information
- Sridhar Kasturi1
Patient initials or identifier number
Relevant clinical history and physical exam
60 years old male presented with chest pain (burning type) associated with giddiness and presented with Recent Anterior wall Myocardium Infarction. No prior history of SOB, palpitations, sweatings, CVA, CKD, LRTI.
Relevant test results prior to catheterization
ECG showed Anterio-septal wall MI.
2DEcho revealed RWMA+, sclerotic aortic valve, no AR, mild MR, trivial TR, no PAH.
Moderate LV dysfunction.
Relevant catheterization findings
Coronary angiogram revealed LAD-ostio proximal LAD 90% calcific lesion, mid 100% occluded, D1- Total occlusion and retrogradely from RCA, RCA-Proximal to mid 80-90% long segment lesion.
Procedure performed through Right Femoral Artery, LMCA engaged with 6 Fr XB 3.5 Guiding catheter which revealed LAD ostioproximal 90% calcific lesion, mid 100% occlusion. LAD crossed with 0.014”sion blue wire with Fine cross microcatheter support and sion blue wire exchange with 0.009x300cm Rota floppy wire, Rotablation performed with 1.5mm Rota Link Plus. Predilatation done with 2.5x15mm, 2.75x15mm NC Trek balloons. Pre procedure OCT (Optical Coherence Tomography) study showed minimal lumen area 2.2 sqmm with 90% calcific lesion with dissection. Distal LAD Stenting done with 2.5x28mm Absorb Stent (BVS), Distal to mid LAD overlapping stenting done with 3.0x28mm Absorb Stent (BVS), Proximal to mid LAD overlapping stenting done with 3.25x33mm Xience Xpedition Stent (DES).Post procedure OCT study showed malapposition in mid to distal LAD stent, Post dilatation done with 3.0x15mm, 3.5x15mm NC Trek Balloons. Post IVUS study showed malapposition, post dilatation done with 4.0X08mm NC Trek Balloon. After Post dilatation IVUS study showed well apposed stent struts, no dissection, no residual stenosis, subsequently patient developed bradycardia, and hypotension. Check angiogram revealed spasm of distal LMCA, ostial LAD with contrast stasis. LAD and LCX were rewired, NTG was given. Subsequent check angio revealed no spasm with good distal flow. The final result was good with TIMI-III Flow and no complications. Patient was discharged after post procedure in a stable status.
Severe and diffusely calcified proximal, mid and distal LAD PCI was done with 2-BVS and 1-DES. Rotablation of LAD was done due to severely calcified LAD for better delivery of stents and adequate expansion of the stents. OCT was used for optimization of complex PCI outcome.