THIS TALK WAS PRESENTED ON 6/6/2015 IN BANGKOK AT A FOCUS GROUP CONFERENCE ORGANISED BY BOSTON SCIENTIFIC TITLED MASTER THE COMPLEX
Baseline angiogram
Heavily calcified distal left main
Previous stent in LCx and LAD
The cranial views
Shows the calcium and the previous stents
1st attempt at pre-dilatation
3.0 x 15 balloon up to max pressure
IVUS of LAD/LCx/LM
Ostium LAD
Ostium LCx
Distal LM
Further dilatation
NC 4.0 balloon along LAD and LM to max pressure
What to do next?
LM shows dissection after aggressive pre-dilatation but calcium has not cracked
Weighing options
- Give up and go for medical therapy
- Call surgeon
- Rotablation
- Which one 1st?
- What to do with LCx?
- If I rota LAD, would I lose LCx?
Stent LCx first
3.0 x 12 Stent in LCx ostium
Rotablation of Left Main
- Felt safe to remove LCx wire
- 1.75 burr down LM/LAD
After the rotablation
The plaque has been modified LM looks presentable and LCx uncompromised
LM stent
3.0 x 33 stent placed from LM ostium
Final kissing and NC dilatation
NC 4.0 balloon in LAD, NC 3.0 balloon in LCx
Final IVUS
LAD carina
Distal Left Main
Final angiogram
RAO cranial and AP caudal views
Final Compare
