Rotablation of Left Main Coronary, Guided by IVUS

By Dharmanath Yadav


Dharmanath Yadav


Dharmanath Yadav1


Shahid Gangalal National Heart Centre, Kathmandu Nepal, Nepal1,
View Study Report
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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Relevant 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

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.

Case Summary

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.