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RCA with massive calcifications

Case of the Month: April 2018

This didactic procedure concerns a 67 years old male with history of coronary artery disease presenting unstable angina and diffusely calcified and multilevel Right coronary artery lesions,  
These lesions were prepared  with rotational atherectomy and  stent implantations were guided by IVUS.
 

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Protocol

  • OptiRAY® (Ioversol)
  • Concentration 350 mgI/ml
  • Flow rate: 8 mL/ s
  • Volume: 228 mL
  • Total exposure : 8.2 Gy
  • Exposure time: 62 minutes
  • 15 images / slow dose Philips

Learning points

  • Lesions selection for Rotational atherectomy.
  • How to prepare  and use the device.
  • Guiding catheter, guidewire  and Burr size selection.
  • How to perform multilevel plaque modification.
  • Guiding catheter extension to improve support and stent delivery.
  • IVUS assessment before and after stenting.

Step-by-Step Procedure

  • Arterial Femoral access 7F, Temporary pace-maker insertion and RCA catheterization with JR4 7F Guiding catheter.
  • Crossing the lesion using Whisper LS coronary PCI guidewire.
  • Exchange the Coronary guidewire with Rotawire Extra support guidewire using a Finecross microcatheter.
  • Rotational atherectomy runs from proximal RCA to the distal bifurcation with 1.5mm Burr.
  • IVUS assessment showing optimal plaque modification.
  • Predilatation with 3.0x20mm balloon and Rotawire exchange to BMW 0.014 guidewire.
  • Stenting of the distal bifurcation with 4.5x18mm Onyx Drug Eluting Stent using Guideliner catheter extension.
  • Stenting of the distal PL with 3.5x12mm Onyx stent for dissection.
  • Stenting of the Mid and Proximal RCA .
  • IVUS control of the final result.

Biobliography



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