03/08/2025
🫀 Challenging Complex PCI Case | Rotational Atherectomy for Calcified LAD Lesions
📍 Ajinkyatara Hospital , Satara
👩⚕️ 60-year-old female | Known case of Diabetes Mellitus, Hypertension, Rheumatoid Arthritis
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🔎 Clinical Presentation:
▪️ Crescendo angina (FC III) for 1 month
▪️ Intermittent rest angina episodes
▪️ Normal LV function on echocardiography
📸 CAG Findings:
▪️ LAD: Heavily calcified artery
▪️ Two tandem 90% stenotic lesions
▪️ Management options discussed: CABG vs PCI with calcium modification
▪️ Patient declined CABG – proceeded with PCI using Rotational Atherectomy (RA)
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🛠 Procedure Highlights:
➡️ Access: Right femoral artery, 7 Fr sheath
➡️ Guide: EBU 7 Fr
➡️ Wire: BMW workhorse wire crossed lesion ➡️ Exchanged for Rotawire using Finecross microcatheter
➡️ Rotational Atherectomy:
🔹 RotaPro device
🔹 1.75 mm burr @ 160,000 RPM
🔹 Initial debulking done
➡️ Balloon Pre-dilation:
▪️ 3.0 x 12 mm NC balloon → Dog-boning seen, lesion resistant
▪️ 3.0 x 12 mm Wolverine cutting balloon → Ruptured
⚠️ Challenge: Severely calcified lesion, non-yielding to NC & cutting balloon
💰 Cost constraints limited use of Imaging or IVL, OPN NC, or larger burr
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🔄 Second Round of Rota:
▪️ Same 1.75 mm burr, increased to 180,000 RPM
▪️ Used different guide catheter and wire positions to improve wire bias
▪️ Successful further debulking
💪 Breakthrough:
▪️ Lesion opened with 3.25 x 10 mm NC balloon @ 18 ATM
▪️ Stented with 3.5 x 28 mm DES
▪️ Post-dilated with 3.75 x 10 mm NC @ 18 ATM
⚠️ Distal stent edge dissection noted
🔧 Covered with 3.0 x 20 mm DES
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✅ Final Result:
▪️ Excellent luminal gain
▪️ TIMI III flow
▪️ No residual stenosis
▪️ Patient stable and pain-free post-procedure
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📌 Takeaway:
In heavily calcified coronary lesions, RotaPro-guided PCI with careful technique modification and strategic debulking can achieve excellent outcomes—even in cost-limited settings.
Hospital, Satara
