MR PVR, 79 YEAR GENTLEMAN.

PATIENT IS A KNOWN DIABETIC, HYPERTENSIVE AND HYPOTHYROID, PRESENTED WITH RECENT ONSET REST ANGINA ASSOCIATED WITH DIAPHORESIS. ON EXAMINATION HIS VITALS WERE STABLE AND CARDIOVASCULAR EXAMINATION WAS UNREMARKABLE WITH NO SIGNS SUGGESTIVE OF HEART FAILURE.

HIS ECG SHOWED SINUS RHYTHM WITH LBBB, WITH QRS DURATION OF 140MS. ECHO SHOWED PARADOXICAL IVS WITH FAIR LV FUNCTION. HIS BASELINE LAB PARAMETRES SHOWED HB OF 13.9 AND NORMAL RENAL PROFILE WITH ELEVATED CARDIAC BIOMARKERS (TROPONIN AND CPK-MB). 

HIS CAG SHOWED CALCIFIED DVD WITH BORDERLINE LESION (50%) IN PROXIMAL LAD AND CALCIFIED DOMINANT RCA WITH OSTIAL 80% STENOSIS, MID DISCRETE LESION WITH 80% STENOSIS AND DISTAL TUBULAR LESION WITH 90% STENOSIS. POST CORONARY INJECTION HE DEVELOPED TRANSIENT CHB. EP CONSULTATION WAS TAKEN AND HE UNDERWENT DUAL CHAMBER PPI FOLLOWED BY RCA REVASCULARIZATION.
CAG.mp4

PLAN: PLAQUE MODIFICATION STRATEGY: UPFORNT ROTABLATION FOLLOWED BY PREDILATION WITH NC BALLOON, +/- LITHOTRIPSY. RIGHT FEMORAL 7F ACCESS, RCA ENGAGED WITH 7F JR 3.5 GUIDING CATHETER. LESION CROSSED WITH BMW GUIDE WIRE, LATER EXCHANGED WITH FLOPPY ROTA WIRE WITH THE SUPPORT OF MICROCATHETER. ROTABLATION DONE WITH 1.5MM ROTA BURR. GENTLE OSTIAL ROTABLATION WAS DONE TO PREVENT OSTIAL DISSECTION. ROTABLATION WAS DONE FROM PROXIMAL TO DISTAL RCA WITH SYSTEM ADVANCING IN DYNA MODE. FLOPPY WIRE WAS EXCHAGED WITH BHW GUIDE WIRE WITH THE SUPPORT OF MICROCATHETER. SERIAL PRE-DILATION DONE WITH 2.5 X 12 MM AND 3 X 12 MM NC BALLOONS AT HIGH PRESSURES. AS THERE IS ADVENTITIAL CALCIUM AND LESION PREPARATION WAS INADEQUATE, FURTHER PLAQUE MODIFICATION WAS DONE WITH SHOCK WAVE C2, 3.5 X 12 MM IVL BALLLON WITH THE HELP OF 6F GUIDE LINER. DISTAL TO MID RCA WAS STENTED WITH 3 X 38 MM DES WITH THE SUPPORT OF GUIDELINER AND OSTEO-PROXIMAL RCA STENTED WITH 3.5 X 48MM DES OVERLAPPING WITH DISTAL STENT. POST DILATION DONE WITH 3 X 12 MM AND 3.5 X 12 MM NC BALLON AT 16-18 ATM. POST PROCEDURE GOOD RESULT ACHEIVED WITH TIMI III FLOW WITH NO RESIDUAL STENOSIS OR EDGE DISSECTION.
ROTA 1 WITH 1.5MM.mp4
ROTA 2.mp4
ROTA 3.mp4
FLOPPY WIRE EXCHANGED WITH BHW.mp4
PRE DILATION 1.mp4
PRE DILATION 2.mp4
6F GUIDELINER FOR IVL INTRO.mp4
IVL 1.mp4
IVL 3.mp4
IVL 5.mp4
STENT 1 DEPLOY.mp4
STENT 2 DEPLOY.mp4
POST DIL 1.mp4
POST DIL 4.mp4
FINAL RESULT.mp4