Abstract
A 69-year-old female was admitted for unstable angina. She had cardiovascular risk factors of diabetes mellitus, hypertension, and hyperlipidemia. She also had end-stage renal failure secondary to diabetic nephropathy and was on hemodialysis. She presented with severe chest pain 1 month prior to presentation. A diagnostic angiogram done earlier showed severe critical left main disease (Fig. 10.1a, b; Video 10.1a, b). Physical examination was unremarkable. After discussion, she declined high-risk surgery and decided for high-risk PCI.
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This shows the severe calcific stenoses of the LM and LAD (MPG 1374 kb)
This shows the severe calcific stenoses of the LM and LAD (MPG 1305 kb)
This shows rotational atherectomy being performed at 150,000 rpm. Note the gentle contact against the lesion, allowing for a “sandpapering” effect (MPG 1272 kb)
This shows the sluggish slow or slow flow after rotational atherectomy (MPG 986 kb)
This shows rotational atherectomy with a 2.0 mm burr (MPG 1275 kb)
The flow in the LAD after rotablation is now TIMI 3 (MPG 538 kb)
These movies show the excellent final angiographic results (MPG 949 kb)
These movies show the excellent final angiographic results (MPG 1102 kb)
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Fam, J.M., Lim, S.T. (2018). Complex Case: LM and LAD. In: Low, R., Yeo, K. (eds) Clinical Cases in Coronary Rotational Atherectomy. Clinical Cases in Interventional Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-319-60490-9_10
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DOI: https://doi.org/10.1007/978-3-319-60490-9_10
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