Rota Savior in Rota Regret

By Rustem Dautov


Rustem Dautov


Rustem Dautov1


The Prince Charles Hospital, Australia1,
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Complex PCI - Calcified Lesion

Rota Savior in Rota Regret

Rustem Dautov1

The Prince Charles Hospital, Australia1,

Clinical Information

Relevant Clinical History and Physical Exam

79/F with angina and moderate-severe AS. Transferred for PCI from another hospital after diagnostic cath showing LAD and RCA disease. For TAVI in the near future. No imaging was used. The case is about aorto-ostial disease is a subset of calcific lesions that have different rules of treatment. They require more respect than just coronary calcium.


Relevant Test Results Prior to Catheterization

nil relevant

Relevant Catheterization Findings

Prox LAD and mid RCA and aorto-ostial RCA disease. Prox LAD and mid RCA stented succesfully. Ostial RCA predilated with NC and 3.5 IVL, then stented with 4.0x18 stent with immediate ostial dog-boning sign. Long battle followed with 3.5 and 4.0 OPN at 40 atm, 3.5 IVL. Unsuccessful. Referred to our complex PCI program.
21 OPN 4.0.mp4

Interventional Management

Procedural Step

The Powerpoint presentation I have is a professional presentation of the case step-by-step. It teaches about IVUS/rota/orbital regret. 1:1 aorto-ostial tretment with cutting balloon +/- OPN. Very meticulous preparation. Fresh 2 days old stent with dog boning at the RCA ostium. IVL did not work. 8F femoral. Very careful/ stepwise approach with rota: 1.5 burr, then 1.75 and finally 2.0. Has to be on rota extra support wire to biase to the inferior wall (6 o'clock), i.e to groove the lesion (stent plus calcium). Guided by imaging...


Case Summary

Lots of teaching points and step-by-step rota of fresh ostial stent with dog boning.How to prevent it and if you are to deal with this situation - how to fix it. The power point has it all but limited space here.