Heavily calcified Left Main Artery stenosis requiring Rotablation

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

p43

Ostium LCx

p44

Distal LM

p45

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

p46

Distal Left Main

p47

Final angiogram
RAO cranial and AP caudal views

Final Compare

p48
p49
Tags: