PCI of Underexpanded LAD-D2 Bifurcation ISR using Rotational/Laser Atherectomy followed by re-DES and/or DCB - March 17th, 8AM

76-year-old male presented with non-STEMI (peak HSTn 124)  and CCS Class IV angina. A Cardiac Cath on November 28, 2025 revealed calcified 1 V CAD: 90-95% proximal LAD and D2 bifurcation ISR disease with underexpanded stents, SYNTAX Score of 13 and EF 45%. Prolonged attempt to advance various guidewire and multiple small balloons including 1mm barely crossed the lesion, but with limited success in expanding the stent. IABP was inserted subsequently patient did well and discharged home after 2 days. Patient now has progressive angina despite multiple anti ischemic medications. Now planned for imaging guided complex LAD/D2 bifurcation underexpanded stents using Rotational/Laser atherectomy followed by re-DES and/or DCB.