Case 175: Manual of PCI - Diffusely diseased calcified LAD

A patient was referred for PCI of a diffusely diseased and heavily calcified LAD. We were unable to wire all the way to the distal vessel and were also unable to deliver several balloons and microcatheters including Sapphire 1.0, Takeru 1.5, MicroRx despite doing grenadoplasty. We obtained contralateral access to visualize the distal LAD and successfully advanced a Fielder XTR distally. However, microcatheters and balloon could still not cross to the distal LAD. We advanced a microcatheter as far as possible in the LAD, removed the Fielder XTR and advanced a Rotafloppy wire to the distal LAD. After multiple rounds of rotational atherectomy we could deliver larger balloons and restore antegrade flow. Due to small distal vessel size, only the proximal LAD was stented with a DES.

[@zadigbalaban8359]

Very nice result, Dr Brilakis and Friends.

[@shangz0216]

Thanks for the excellent case presentation.

[@ahmedzahran7016]

Thanks for the excellent case presentation. May I ask why you didnt consider wire escalation from the start?

[@toni3730]

Thank you for sharing! 😀

[@NikhilJha89]

What about the dissections caused distally by rotablation?

[@mahmoud_elrayes]

Excellent result. Why did you withdraw the left gear(catheter...wire) during contralateral injection 1:58 ? Thank you.

[@johnwilson7660]

I wonder if anybody has successfully tried a wire other than the rotawire with rotablator given how difficult it can be to deliver it distally. I've seen CSI used over a gladius mongo successfully. Maybe shockwave's catheter with the forward facing transducer will make things easier in the future.