Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 70-year-old male was a hemodialytic patient with angina pectoris, whose angiogram showed severe stenosis in the proximal RCA. On the other hand, he was required to undergo a surgery to treat cholangiocarcinoma as soon as possible. Therefore, it was intolerable for him to take dual antiplatelet therapy (DAPT). Then, we planned to perform coronary revascularization using a directional coronary atherectomy (DCA) instead of stenting strategy.
Relevant test results prior to catheterization
Relevant catheterization findings
Severe stenosis in the proximal RCA.
An 8-Fr guiding catheter (Hyperion JR 4.0 SH, ASAHI INTECC) inserted into the RCA via a right femoral artery. A floppy guide wire (Run through NS Ultra Floppy, Terumo) successfully passed through the lesion. Then, it was exchanged to a support guide wire (ASAHI Grand Slam, ASAHI INTECC.) using a microcatheter. In addition, the IVUS and the OFDI showed a calcified nodule in the target lesion. We attempted to cross the DCA catheter (ATHEROCUT, Nipro) to the lesion but it could not pass. Then, the lesion was dilated by a 2.5 mm scoring balloon (Lacrose NSE ALPH, Goodman). After that, the DCA catheter successfully passed through the lesion and we performed 8-times atherectomy. Additionally, the lesion dilated by a 4.0 mm scoring balloon (Lacrose NSE ALPH), and the final residual stenosis was 25% stenosis.
A stentless PCI strategy using a DCA seemed to be a niche but a necessary option to the intolerant case for DAPT.