CASE20230825_005
Rotablation of Left Main Coronary, Guided by IVUS
By Dharmanath Yadav
Presenter
Dharmanath Yadav
Authors
Dharmanath Yadav1
Affiliation
Shahid Gangalal National Heart Centre, Kathmandu Nepal, Nepal1,
View Study Report
CASE20230825_005
Complex PCI - Left Main
Rotablation of Left Main Coronary, Guided by IVUS
Dharmanath Yadav1
Shahid Gangalal National Heart Centre, Kathmandu Nepal, Nepal1,
Clinical Information
Relevant Clinical History and Physical Exam
No Family History of TB, CancerPatient is a known case of Hypertension, SmokerOn Examination, Patient's General Condition was FairPulse Rate : 60/minBP: 110/70 mmHgCardiovascular System: s1+s2+M0Respiratory System: within Normal Limit
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Video 1.mp4 Video 2.mp4 Video 3.mp4Relevant Test Results Prior to Catheterization
Haematology;HB: 12.0Platelets: 302000WBC: 10000Neutrophiles: 80Lymphocytes: 15Monocytes: 3Eosinophils: 2
Biochemistry;RFT: Urea/Creatinine 3.3/56Na/K: 138/4.3
Lipid Profile;T. Cholesterol: 3.6 mmol/LTriglyceride: 1.5 mmol/LHDL Cholesterol: 0.9 mmol/LLDL Cholesterol: 2.0 mmol/L
Biochemistry;RFT: Urea/Creatinine 3.3/56Na/K: 138/4.3
Lipid Profile;T. Cholesterol: 3.6 mmol/LTriglyceride: 1.5 mmol/LHDL Cholesterol: 0.9 mmol/LLDL Cholesterol: 2.0 mmol/L
Relevant Catheterization Findings
1) Coranary Artery Disease, Status Post PCI to RCA2) Triple Vessel Disease with Distal Left Main Bifurcation Severe Calcification
Interventional Management
Procedural Step
Via Right Radial Artery Left Main was Hooked with 7F Guiding Catheter, Angio Shots were Taken.Wiring was Done with Floppy Wire and IVUS was Performed that showed Severe Calcification of Left Main Extending to Proximal LAD.
Floppy Wire was Exchanged with ROTA Wire and by following all the steps of Rota Procedure, Rotablation was Performed with 1.5mm Burr with RPM 150000 to 170000 three times. Then again ROTA Wire was Exchanged with Floppy Wire and Ballooning was done with 3 x 12 mm NC Balloon.Drug Eluting Stent of Size 3 x 30 mm was Deployed at ATM 12 mmHg.Post Ballooning was Done with 3.5 x 12 mm NC Balloon at ATM 16 mmHg and with the Same Balloon POT was done to Left Main at ATM 18 mmHg.Final Angio Shot was Taken, that Revealed Good End Result.
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Floppy Wire was Exchanged with ROTA Wire and by following all the steps of Rota Procedure, Rotablation was Performed with 1.5mm Burr with RPM 150000 to 170000 three times. Then again ROTA Wire was Exchanged with Floppy Wire and Ballooning was done with 3 x 12 mm NC Balloon.Drug Eluting Stent of Size 3 x 30 mm was Deployed at ATM 12 mmHg.Post Ballooning was Done with 3.5 x 12 mm NC Balloon at ATM 16 mmHg and with the Same Balloon POT was done to Left Main at ATM 18 mmHg.Final Angio Shot was Taken, that Revealed Good End Result.
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RA to facilitate interventional procedures in very complex heavily-calcified LMCA lesions could be safely accomplished with a very low complication rate.
Atherectomylablation with stent placement, guided by IVUS may enhance procedural and long-term outcome.
Coronary Imaging with IVUS gives the nature and distribution of Calcium.
Growing data from observational studies and randomized controlled trials have confirmed the clinical benefit of IVUS guidance during PCI.