Mini Crush with Rota Ablation

Abstract

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.