CASE20230823_008
Rota Savior in Rota Regret
By Rustem Dautov
Presenter
Rustem Dautov
Authors
Rustem Dautov1
Affiliation
The Prince Charles Hospital, Australia1,
View Study Report
CASE20230823_008
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.
03.mp4Relevant 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
21 OPN 4.0.mp4Interventional 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...
45.mp4
59.mp4
45.mp4 59.mp4Case 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.