Complex PCI - Calcified Lesion
Manage the Calcium but Don’t Forget the Diagonals
Thomas TH Lam1, Frankie CC Tam1
Queen Mary Hospital, Hong Kong, China1,
Mr Leung was an 85 years old man who suffered from hypertension on losartan. He was admitted for acute non-ST segment elevation acute coronary syndrome. Physical examination was unremarkable. His vital signs were stable. MOVIE-0002.mp4 MOVIE-0003.mp4 MOVIE-0004.mp4
Coronary angiogram showed calcified triple vessel disease. Left main mild stenosis, Left anterior descending artery (LAD) tandem 90-95 % stenosis from proximal to mid portion. Left circumflex artery was non-dominant with a 70 % stenosis over obtuse marginal branch. Right coronary artery had a focal 70 % stenosis over proximal part a 95% critical stenosis over posterolateral branch.
Calcified lesions can be difficult to management. Atherectomy device may need to be deployed for better lesion preparation. Protruding calcium may result in entrapment of equipment and wiring difficulties. It is important not to overlook the diagonals and they may result in acute vessel closure and hemodynamic compromise. We should be comfortable in handling complications and be familiar with bail out strategies in case of complications.