Case and plan :
Case and plan
76yrs, F post CABG
Present Clinical Presentation
Presented with new onset CCS class III angina and recent stress MPI for apical & lateral ischemia (4/23)
CAD Risk Factors
PAD s/p PTA
Multiple CAD risk factors, s/p CABG x2 6/21. Stress MPI was negative in 7/2022. Known PAD s/p PTAs.
PAF failed ablations
Cath: Cath on May 5th 2023 revealed 3 V+LM CAD with patent LIMA-RIMA Y graft; calcified 90% dLM, 80% calcified LAD with 80% D2 bifurcation (1,1,0), 80% pLCx, 100% RCA fills distally via collaterals and LVEF 62%. Pt developed CHB requiring temporary PM after cath but need for PPM.
Plan: Now planned for IVUS guided complex PCI of LM bifurcation and LAD/D2 using rotational atherectomy and DES with MiniCrush technique.