Mini Crush with Rota Ablation


  • Saleha Haroon Rawalpindi Institute of Cardiology Rawalpindi - Pakistan


Complex bifurcation stenting, Rota ablation, Calcific left anterior descending artery (LAD), Ramus intermedius, Intravascular imaging


Background: Coronary artery disease (CAD) remains a significant cause of morbidity and mortality worldwide, particularly in elderly individuals. Complex coronary lesions, such as bifurcation disease with calcific plaques, further exacerbate the treatment dilemma, necessitating innovative approaches to revascularization.

Case Presentation: An 85-year-old frail male, normotensive and normoglycemic, presented with non-ST segment elevation myocardial infarction (NSTEMI). Angiogram revealed triple vessel disease, with particularly critical involvement of the distal left main stem (LMS) and complex bifurcation disease in the proximal left anterior descending artery LAD and ostioproximal course of Ramus intermedius. Despite referral for coronary artery bypass grafting (CABG), surgical intervention was deemed unsuitable due to the patient's advanced age and frailty.

Management & Results: The patient underwent mini crush bifurcation stenting from LMS to LAD and Ramus intermedius, preceded by rota ablation of the calcific LAD lesion. The final outcome, assessed by intravascular ultrasound (IVUS) imaging, demonstrated optimal results.

Conclusion: In elderly, frail patients with triple vessel coronary artery disease (TVCAD) who are unsuitable candidates for surgery, complex bifurcation stenting can be a viable option. However, meticulous lesion preparation and IVUS-guided revascularization are crucial, especially in cases involving left main stem bifurcation stenting, to improve procedural outcomes.


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Hildick-Smith D, Arunothayaraj S, Stankovic G, Chen SL. Percutaneous coronary intervention of bifurcation lesions. EuroIntervention. 2022;18(4):E273–91.

Malaiapan Y, Leung M, White AJ. The role of intravascular ultrasound in percutaneous coronary intervention of complex coronary lesions. Cardiovasc Diagn Ther. 2020;10(5):1371–88.




How to Cite

Haroon, S. (2024). Mini Crush with Rota Ablation. Cathalogue, 2(1), 10–16. Retrieved from