Author + information
- Masayuki Sakurai1
Patient initials or identifier number
Relevant clinical history and physical exam
An 82-year-old man admitted to the other hospital because of subdural hematoma. During the admission, ventricular tachycardia and ventricular fibrillation suddenly occurred. The complications were caused by low EF and hypokalemia. Therefore, after correcting hypokalemia, he was admitted our hospital because CAG was checked.
Relevant test results prior to catheterization
Baseline ECG showed negative T inI, aVL, V3-6. Echocardiogram revealed diffuse severe hypokinesis with LV function (ejection fraction 36%).
Relevant catheterization findings
Left angiogram showed severe calcified lesions in the proximal and mid LAD. A severe stenosis in the proximal HL, and a CTO lesion in the proximal LCX. A right angiogram showed a CTO lesion in the proximal RCA. At first, RCA CTO PCI performed successfully using two drug-eluting stents.
The target legion was severe calcified lesions in the LAD. A 7Fr VL 3.5 SH was engaged in the LCA. A guidewire has crossed the lesion. However, any devices could't pass at the distal lesion. Therefore, a bare Rota floppy has crossed the lesion. A 1.5 mm Rotablator ablated with 185000 rpm. However, after the first ablation in the proximal lesion, slow flow occurred. So, the flow was improved using infusion catheter “LUMINE” with sodium nitroprusside hydrate and IABP. After that, it ablated again. However, it couldn't pass the distal lesion. Therefore, the burr size was down. Nevertheless, neither 1.5 mm nor 1.25 mm Rotablator could pass the distal lesion. Therefore, we gave up this session. Three weeks later, we tried the second session. An 8Fr VL 3.5 SH was engaged in the LCA. A 1.5 mm Rotablator started to ablate with 200000 rpm in the LAD. In this session, after ablation in the proximal LAD slow flow did not occur. However, 1.5 mm burr couldn't pass the distal lesion. Therefore, the wire exchanged to Rot Wire Extra Support, and the rotation speed increased to max speed. However, the bur couldn't pass. After that burr size was down. Finally, 1.25 mm burr with max rpm could pass the lesion. Then, a drug coated balloon dilated in the distal LAD and a drug-eluting stent implanted in the proximal LAD. Finally, successful revascularization achieved in the LAD severe calcified lesion.
A PCI performed for triple vessel disease including LAD severe calcified lesion. At First CTO PCI for RCA performed. Next, PCI was performed for LAD severe calcified lesion. Rotablator was necessary because of severe calcium. However, neither 1.5 mm burr nor 1.25 mm but could pass the lesion. Moreover, slow flow occurred at the every ablation. Therefore, we had to give up at the first session. At the second session, PCI system was stronger back-up than the first session. Therefore, 1.25 mm burr could pass the lesion. Finally, successful revascularization achieved in the LAD severe calcified lesion.