A rock along the road

Abstract

Background: Coronary calcification poses a significant challenge for interventional cardiologists, often leading to procedural complexities and suboptimal outcomes. Lesions that appear non-severely calcified angiographically may pose unexpected difficulties during percutaneous coronary intervention (PCI), necessitating the use of intravascular imaging for accurate lesion assessment and procedural planning.

Case Presentation: We present the case of a 52-year-old hypertensive male who presented with non-ST elevation myocardial infarction (NSTEMI) to Chaudhary Pervaiz Elahi Institute of Cardiology. Initial management was conservative, and subsequent coronary angiography revealed a mid-left anterior descending artery (LAD) lesion at the origin of a prominent diagonal branch. Despite attempted PCI, the lesion proved resistant to conventional treatment modalities. Subsequent intravascular ultrasound (IVUS) imaging identified a calcific spur impinging the vessel lumen, prompting the decision for rotational atherectomy followed by successful stenting with a drug-eluting stent (DES).

Management and Results: The patient underwent staged PCI with rotational atherectomy, leading to effective lesion modification and subsequent stent deployment. IVUS-guided optimization ensured optimal post-stenting results, with the patient tolerating the procedure well and experiencing resolution of symptoms.

Conclusion: This case underscores the importance of employing intravascular imaging, particularly in the presence of coronary calcification, to guide procedural decision-making and optimize post-stenting outcomes. By incorporating IVUS into routine practice, interventionalists can enhance procedural success rates and improve long-term clinical outcomes in patients with complex coronary artery disease.