Complex coronary cases
Recanalization of a complex RCA CTO using Antegrade/Retrograde Approach – Oct 2019

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50-year-old female with multiple CAD risk factors presented with new onset CCS Class II angina for two months and stress echo revealed moderate inferior ischemia. A Cardiac Cath on October 7, 2019, performed at an outside hospital, revealed 1 V CAD: CTO of prox RCA, which fills via collaterals from left system with non obstructive left system, SYNTAX Score of 9 and LVEF 60%. The RCA CTO is long and calcified with J-CTO Score of 4. Patient is now planned for PCI of RCA CTO using rotational atherectomy and stents via antegrade approach and if failed, then retrograde approach.

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Imaging Guided Calcified LM PCI with Interactive Discussion about EXCEL Trial Results by Dr. Gregg Stone and Dr. John Puskas – November 2019
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Case and Plan: 77 year-old male with stable class II angina and exertional dyspnea was noted to have calcified 90-95% left internal carotid artery stenosis on carotid duplex for ongoing neurological symptoms. A Cardiac Cath on November 18, 2019 as the part of pre-op evaluation for carotid endarterectomy revealed calcified severe 2V (RCA and LCx) […]


Impella Assisted Protected Multivessel PCI using Rotational Atherectomy – Sept 2019
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62-year-old male presented with new onset Class III angina, NIDDM and positive MPI for multivessel ischemia in inferior, lateral and anterior walls. A Cardiac Cath on September 6, 2019 revealed 3V CAD: 100% proximal RCA, 80% calcified proximal LAD/D1 bifurcation Medina (1,1,1), calcified 80% mid LAD, calcified diffuse subtotal LCx-OM2 with SYNTAX Score of 39 […]


FFR & OCT Guided Staged PCI of LAD Diagonal Bifurcation – Aug 2019
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50-year-old female with new onset Class II angina and strongly positive stress MPI for multivessel myocardial ischemia with TID. A Cardiac Cath on June 26, 2019 revealed 3V CAD: 70% severely calcific prox LAD with diagonal bifurcation, 80% LCx-LPL, 80% mid RCA with SYNTAX Score of 23 and LVEF of 60%. Patient underwent successful DES […]


Complex PCI of 20 year old multiple CTO Lesions of RCA – July 2019
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Case and Plan 82-year-old female with NIDDM and prior CABG (1998) & PCI’s presented with CCS Class III angina and high-risk positive stress MPI for multivessel ischemia and normal LV function. A Cardiac Cath on May 21, 2019 revealed III Vessel CAD with totally occluded mid-distal RCA, prox LAD and LCx-OM1, 90% native distal LAD […]