Complex coronary cases
IVUS Guided Orbital Atherectomy and DES of Tortuous Calcified LAD – June 2020

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Case and Plan:

72-year-old male presented with rest angina and Non-STEMI, peak TnI 7.6. A Cardiac Cath on February 6, 2020 revealed 3 V CAD: 95% ulcerated proximal RCA, severely calcified 80-90% proximal and mid LAD, 80% proximal LCx, 70% proximal Ramus Intermedius with LVEF 45% and SYNTAX Score of 32. Patient underwent successful culprit vessel PCI of RCA using Atherotomy and Promus Premier DES. Patient did well and continued to have CCS Class II angina on GDMT. A stress echo on June 18, 2020 revealed near normal LV function and significant anterior wall ischemia. Patient is now planned for IVUS guided orbital atherectomy and multiple stents of tortuous calcified LAD lesions.

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