Diffuse coronary multivessels disease. Complex PCI treatment

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

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.