PCI of Angulated Proximal LCx using Rotational Atherectomy and DES

Case & Plan:
76-year-old female presented with mild angina and a stress MPI as pre-op for shoulder surgery revealed multivessel inferior and lateral ischemia. A Cardiac Cath on July 31, 2023 revealed 2 V CAD: multiple calcified 80-95% lesions in RCA, 95% calcified angulated lesion in proximal LCx with SYNTAX Score of 20 and LVEF 50%. Patient underwent successful interventions of RCA using RA and 3 (Promus Elite) DES. Patient is now planned for staged PCI of angulated proximal LCx using Rotational Atherectomy and DES.

[@jwilson3985]

This is a case that requires 8Fr guide. It also is not a case to use Boston guides bc they fatigue much faster. EBU or XB should be used here. Great case!

[@LofotenDoc]

7F XB 3,5 from radial. Great case

[@areenal-taie6836]

Awesome job ❤

[@jwilson3985]

This is a prime way to lose a stent when a guide is jammed aggressively like this. Fellows should not do this. Nodule + LCX + Weak Guide = common way to lose a stent.

[@shokhrukhabdirimov6376]

What do you think about wire , Drive, ?

[@wilzboyz]

Explain use of 6F system.

[@nisennananem]

A small Rota burr (1.25 to 1.5) is compatible with a 6F guide catheter, although we tend to use 7F system the more complex the case is

[@wilzboyz]

@@nisennananem yes of course-I am an active Rota user. But in a case where you start from the groin, clearly lacked adequate support during the case, and typically use 7F why choose 6F here?