MLM

72 YRS MALEESSENTIAL HTNCKDIHD-AWMI, CARDIOGENIC SHOCK, S/P PRIMARY PCI TO LAD (2016)NOW NSTEMICAD: LAD STENTS PATENT, LCX-OM LONG CALCIFIED DISEASE, RCA CTO
BLOOD BIOCHEMISTRY REVEALED DERANGED KFT, DYSLIPIDEMIA, ELEVATED HSCRP. REST ALL WAS WITHIN NORMAL LIMITS. HE WAS ADVISED STAGED REVASCULARISATION. LCX- OM PCI FIRST FOLLOWED BY RCA PCI AFTER 6-8 WEEKS. 
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BLOOD BIOCHEMISTRY UNREMARKABLECREAT 2.1CK MB ELEVATEDHS TROPONIN ELEVATEDCBC NORMALLFT NORMALHBA1C 6.1DYSLIPIDEMIA ++
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LMCA-> NORMALLAD-> TYPE III, STENT PATENTLCX--> OSTEO-PROXIMAL LONG SEGMENT 90-95% STENOSISRCA--> PROXIMAL CTO
LV ANGIO: NOT DONE

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6 FR TRANSRADIAL APPROAH6 FR XB GC. BMW WIRE.PRE-DILATED WITH TREK 1.2X6 F/B 2.0X12 F/B 2.5X15 NC AT 20-22 ATM. CHECK ANGIOGRAM REVEALED POOR LUMEN GAIN. MULTIPLE ATTEMPTS AT NEGOTIATING FLEX-TOME FAILED. 6 FR GUIDE-LINER USED AND AGAIN MULTIPLE NC BALLOON DILATATION DONE, STILL THE LESION DIDN'T YIELD. BMW EXCHANGED FOR ROTA FLOPPY WIRE. 1.25 BURR USED TO ROTA-BLATE THE ENTIRE LCX-OM SYSTEM MULTIPLE TIMES. ROTA WIRE EXCHANGED FOR BMW AND LESION AGAIN DILATED USING NC BALLOONS.LESION STENTED USING 2 STENTS. CHECK ANGIOGRAM AND STENT BOOST IMAGES SHOWED POOR STENT EXPANSION AT OVERLAP SEGMENT. OVERLAP SEGMENT AGAIN DILATED WITH NC BALLOON, STILL UNDER EXPANSION PERSISTED. OPN NC 2.5X15 USED AT 40 ATM FOR EXPANDING THE POOR EXPANDED SEGMENTS. FINALLY IVL 3.0X15 USED AND ALL 80 SHOVKS DELIVERED. FINAL STENT OPTIMISATION DONE USING 3.0X15 NC BALLOON.

IN THE TIMES OF BETTER HARDWARE, ROTA BLATION, IVL AND OPN NC, SYNERGY OF VARIOUS DEVICES CAN HELP US TACKLE MOST OF THE DIFFICULT CALCIFIED LESIONS. ALL THESE DEVICES HAVE A SYNERGISTIC ROLE TO PLAY IN STATE OF THE ART PCI.