RCA with massive calcifications

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RCA with massive calcifications

Case of the Month: April 2018

This didactic procedure concerns a 67 years old male with history of coronary artery disease presenting unstable angina and diffusely calcified and multilevel Right coronary artery lesions,

These lesions were prepared with rotational atherectomy and stent implantations were guided by IVUS.

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Protocol

OptiRAY® (Ioversol)
Concentration 350 mgI/ml
Flow rate: 8 mL/ s
Volume: 228 mL
Total exposure : 8.2 Gy
Exposure time: 62 minutes
15 images / slow dose Philips

Learning points

Lesions selection for Rotational atherectomy.
How to prepare and use the device.
Guiding catheter, guidewire and Burr size selection.
How to perform multilevel plaque modification.
Guiding catheter extension to improve support and stent delivery.
IVUS assessment before and after stenting.

Step-by-Step Procedure

Arterial Femoral access 7F, Temporary pace-maker insertion and RCA catheterization with JR4 7F Guiding catheter.
Crossing the lesion using Whisper LS coronary PCI guidewire.
Exchange the Coronary guidewire with Rotawire Extra support guidewire using a Finecross microcatheter.
Rotational atherectomy runs from proximal RCA to the distal bifurcation with 1.5mm Burr.
IVUS assessment showing optimal plaque modification.
Predilatation with 3.0x20mm balloon and Rotawire exchange to BMW 0.014 guidewire.
Stenting of the distal bifurcation with 4.5x18mm Onyx Drug Eluting Stent using Guideliner catheter extension.
Stenting of the distal PL with 3.5x12mm Onyx stent for dissection.
Stenting of the Mid and Proximal RCA .
IVUS control of the final result.

Biobliography

European expert consensus on rotational atherectomy - Article
Authors Emanuele Barbato Adam de Belder

Current Status of Rotational Atherectomy - Article
Authors Matthew I. Tomey, Annapoorna S. Kini and Samin K. Sharma
Publication DOI: 10.1016/j.jcin.2013.12.196
Utility of rotational atherectomy and outcomes over an eight-year period. - Article
Authors Couper LT Shaw JA
Publication 2015 Oct;86(4):626-31. doi: 10.1002/ccd.26077.
Rotational atherectomy multicenter registry: acute results, complications and 6-month angiographic follow-up in 709 patients.- Article
Authors Warth DC; Buchbinder M
Publication 1994 Sep;24(3):641-8.

Results of the study to determine rotablator and transluminal angioplasty strategy (STRATAS). - Article
Authors Whitlow PL Feldman T.
Publication 2001 Mar 15;87(6):699-705
Clinical Characteristics and Long-Term Outcomes of Rotational Atherectomy　- J2T Multicenter Registry. - Article
Authors Okai I Daida H
Publication Circ J. 2018 Jan 25;82(2):369-375. doi: 10.1253/circj.CJ-17-0668. Epub 2017 Sep 21.

ROTABLATOR System Didactic training – online Website
Authors Boston Scientific

Actus