U.Y

Clinical Diagnosis: Stable angina
Age:83 years old male 
Past medical history: COPD, Diabetes Mellitus, MDS, Atrial fibrillation, Heart failure 
Present medical history: Sep/2019  PCI to p-RCA was re-attempted (target:prox-RCA).

ECG: negative T in V4-6, poor R in V1-2
Laboratory findings: Hb 8.7 g/dl, T-Chol 125mg/dl, HDL 40mg/dl, LDL 71mg/dl, TG 99mg/dl, HbA1c 6.8%, eGFR 62.3 ml/min, BNP 217.8pg/ml, KL-6 1343U/ml
Chest-X ray: 58%, Cardiomegary(+) 
Echocardiography: EF 39%, antero-septal severe-hypokinesis, apex severe-hypokinesis, mild AS(maxPG 38mmHg, AVA 1.24cmsq)

History: Sep/2018  emergent PCI to mid-LAD(Xience Sierra3.5/12: 99%→0%)                            staged PCI to prox-RCA(POBA+DCB: 90%→25%)                 Jul/2019   CAG:p-RCA 90%(restenosis),                             PCI to mid-LCx(Synergy2.25/12: 90%→0%)

system) TFI:8Fr-Hyperion JR4.0SH
1: Sion blue was inserted for open lumen.2: IVUS examination was performed. 3: Miracle12 with DLC was penetrated inside calcified nodule with IVUS guidance.4: Guidewire was exchanged to rota floppy.5: Debunking by rotablator (2.15mm/180000bpm) was performed with temporary pacing back-up.6: POBA was performed by 4.25mm high pressure balloon .7: Final angiography was assessed.8: CAG follow-up was assessed 1-year later, which showed no significant stenosis by both physiological assessment and IVUS findings.

Calcified nodule sometimes led malignant restenosis after DES implantation. However, ARCADIA technique could be useful strategy for such kind of tough calcified nodule which was considered as difficult to be treated by conventional approach.