Video : Diffuse coronary multivessels disease. Complex PCI treatment

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Cardiology / Coronary / Pci / Case in the box

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This 20 minutes didactic procedure concerns a 64 years old male presenting with anterior wall proven ischemia with diffuse coronary multivessels disease: several calcified mid LAD lesions, first diagonal and left CX lesions, the SYNTAX Score was 14.
These lesions were treated in the same session by multi-instrumental PCI.

Protocol

OptiRAY® (Ioversol)
Concentration 300 mgI/ml
Flow rate: 3.5 mL/ s
Volume: 165 mL
Total exposure : 1.3 Gy
Exposure time: 38 minutes
7.5 images / slow dose Philips
50 images mostly by fluoroscopy

Step-by-Step Procedure

Wiring the distal LAD with a workhorse guidewire.
Predilatation of distal and proximal LAD lesions with a NC balloon 1.5x15mm.
Changing to Rotawire Floppy in the LAD using Finecross microcatheter and trapping technique.
Rotational atherectomy using 1.5mm Burr.
Exchanging the Rotawire to a workhorse guidewire using Aquaplane technique.
Stenting of the distal and proximal LAD lesions using Guiding catheter extension to improve support.
Predilatation of the proximal LAD lesion with Scoring balloon and stenting.
Stenting of the LCX lesion.

Learning Points

How to approach patients with multivessels coronary artery disease.
Microcatheter using for Rotawire placing in tortuous and calcified lesions.
Complex lesions preparation with Rotational atherectomy .
Scoring balloon predilatation as complementary technique for optimal preparation after Rotational atherectomy.
Usefullness of guiding catheter extension to improve backup support and device delivery.
Contrast medium volume control during multivessels PCI.

Biobliography

State of the art: evolving concepts in the treatment of heavily calcified and undilatable coronary stenoses - from debulking to plaque modification, a 40-year-long journey - Article

Authors: Emanuele Barbato

Publication: 2017 Aug 25;13(6):696-705. doi: 10.4244/EIJ-D-17-00473.

Radial Versus Femoral Access for Rotational Atherectomy: A UK Observational Study of 8622 Patients - Article
Authors: Watt J, Austin D, Mackay D, Nolan J, Oldroyd KG.
Publication: 2017 Dec;10(12). pii: e005311. doi: 10.1161/CIRCINTERVENTIONS.117.005311.

Therapeutic effect of rotational atherectomy with implantation of drug eluting stent in heavily coronary calcified patients - Article
Authors: Wei ZH.
Publication: 2016 Mar;13(3):233-8. doi: 10.11909/j.issn.1671-5411.2016.03.013.

The use of a scoring balloon for optimal lesion preparation prior to bioresorbable scaffold implantation: a comparison with conventional balloon predilatation - Article

Authors: Miyazaki T.

Publication: 2016 Apr 8;11(14):e1580-8. doi: 10.4244/EIJV11I14A308.

Shooting date : 2016-11-03
Last update : 2021-05-11

Join the Discussion

Dawood W.
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2018-02-13, 7h46
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apshilava G. Good job

2018-02-23, 0h11
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Roberto B. Nice job. Rota modification of LAD plaque was essential to facilitate the procedure and to allow the passage of stents to distal LAD.

2018-10-11, 17h16
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Pecheux M. Great

2018-11-02, 15h23
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Diffuse coronary multivessels disease. Complex PCI treatment

Case of the Month: February 2018

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