![]() ![]() Patient was admitted to CCU for further decision regarding CABG or another attempt at PCI. ![]() The proximal RCA dissection was treated with a DES. The distal RCA lesion was treated with a 2.25 NC Quantum and 2.0 Angiosculpt without expansion. The 2.5 mm balloon became stuck in the lesion and on retrieval deep seated the guide catheter resulting in a proximal RCA dissection. Three compliant balloons ruptured in the lesion without adequate expansion ( Figure 2(b)). PCI of RCA was undertaken using a 6F AL1 guide and a BMW wire to cross the distal RCA. (f) Final angiographic result after stenting and postdilatation. (d) Advancement of a 1.25 mm rotablation burr through a 7 Fr. ((b) and (c)) Resistant lesion within distal RCA to noncompliant balloon expansion. (a) Tortuous RCA with distal lesion and TIMI 2 flow. Rotablation of the distal RCA, assisted with the insertion of a 7 Fr. The patient was asymptomatic with no cardiac enzyme elevation the following day and, therefore, was discharged home. We treated the OM2 and the proximal LCx with drug eluting stents with excellent final angiographic result ( Figure 1(f)). We had good balloon expansion subsequent to rotablation ( Figure 1(e)). The GuideLiner was then advanced again to the midleft circumflex artery enabling delivery of a 2.5 × 32 Promus Element stent to the proximal OM3. We then placed the burr just distal to the GuideLiner and performed multiple rotational atherectomy runs at 160,000 rpm ( Figure 1(d)). A 1.25 mm burr was advanced through the GuideLiner and easily negotiated the acute takeoff angle of the left circumflex artery ( Figure 1(c)). A 2.5 balloon was used to dilate and anchor in the midleft circumflex artery to facilitate advancement of the GuideLiner to that position. Unfortunately, a 2.25 noncompliant Quantum balloon (Boston Scientific, Natick, MA, USA) was unable to dilate the calcific lesion at high pressure ( Figure 1(b)). sheath and the left main artery was engaged with an XB 3.5 7 Fr. Percutaneous coronary intervention (PCI) using the right transradial approach was performed. The angle of the left circumflex (LCx) artery takeoff from the left main was greater than 90 degrees and its proximal segment had significant calcification as well. Coronary angiography revealed severe 90% proximal OM2 stenosis and a severe calcific 90% stenosis in the OM3 ( Figure 1(a)). A 67-year-old male with known diabetes, hypertension, dyslipidemia, and previous acute inferior STEMI with previous percutaneous intervention of the RCA and PDA presented with CCS class III angina symptoms refractory to maximal medical therapy. ![]()
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