Diffuse coronary multivessels disease. Complex PCI treatment

Case of the Month: February 2018

This 20 minutes didactic procedure concerns a 64 years old male presenting with anterior wall proven ischemia with diffuse coronary multivessels disease: several calcified mid LAD lesions, first diagonal and left CX lesions, the SYNTAX Score was 14.
These lesions were treated in the same session by multi-instrumental PCI.


  • OptiRAY® (Ioversol)
  • Concentration 300 mgI/ml
  • Flow rate: 3.5 mL/ s
  • Volume: 165 mL
  • Total exposure : 1.3 Gy
  • Exposure time: 38 minutes
  • 7.5 images / slow dose Philips
  • 50 images mostly by  fluoroscopy 

Step-by-Step Procedure

  • Wiring the distal LAD with a workhorse guidewire.
  • Predilatation of distal and proximal LAD lesions with a NC balloon 1.5x15mm.
  • Changing to Rotawire Floppy in the LAD using Finecross microcatheter  and trapping technique.
  • Rotational atherectomy using 1.5mm Burr.
  • Exchanging the Rotawire to a workhorse guidewire using Aquaplane technique.
  • Stenting of the distal and proximal LAD lesions using Guiding catheter extension to improve support.
  • Predilatation of the proximal LAD lesion with Scoring balloon and stenting.
  • Stenting of the LCX lesion.

Learning Points

  • How to approach patients with  multivessels coronary artery  disease.
  • Microcatheter using for Rotawire placing  in tortuous and calcified lesions.
  • Complex lesions preparation with Rotational atherectomy .
  • Scoring balloon predilatation as complementary technique for optimal preparation after Rotational atherectomy.
  • Usefullness of guiding catheter extension to improve backup support and  device delivery.
  • Contrast medium volume control during multivessels PCI.


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