Challenging Rotablation assisted Percutaneous Coronary Angioplasty to LAD and LCX

Abstract

Background: Rotational atherectomy (RA) is used for treating severely calcified and complex lesions during percutaneous coronary interventions (PCI).

Case Presentation: A 70 years old male, diabetic and hypertensive, with failed PCI at another facility for calcified dominant left circumflex artery disease (LCX) was scheduled for rotablation assisted PCI.

Management: The angiogram showed a calcified critical lesion in the proximal part of the Left anterior descending artery (LAD). A large dominant LCX with a severely calcified and badly dissected lesion in the mid part. LAD was rotablated with 1.75mm burr followed by a 3.5mm DES. Guidezilla was deep throated in LCX and to support Corsair half way across the mid LCx lesion. Re-Wired from here with Rota floppy. Distal LCX was rotablated with a 1.25mm burr and proximal to the mid part with a 1.75mm burr. The lesion was dilated with noncompliant balloon. Two overlapping DES were deployed via Guidezilla. Both stents were post-dilated with a 3.5mm NC balloon. The patient went home the next day without any complications. At one year follow-up, he was asymptomatic with improved ejection fraction (EF) of 50%.

Conclusion: Patient with reduced EF usually requires LV assist devices such as Impella during such complex interventions, which is considered unaffordable in our setting. Multivessel rotablation is considered high risk in elderly patients with reduced EF, however if planned and performed correctly can help in such cases.