Complex RA of Severely Calcified Circumflex - December 2023

Case and Plan
79-year-old male presented with NSTEMI and chronic systolic heart failure. A Cardiac Cath on October 2, 2024 revealed calcified 3 V CAD: 80-90% multiple LCx branches, 95% proximal LAD-D2 bifurcation, 95% proximal RCA with SYNTAX Score of 36 and LVEF = 35%. Patient was turned down for CTS due to small diffuse CAD. Then underwent successful Impella assisted Rota DES PCI of proximal RCA and proximal LAD with excellent results. Patient is now planned for IVUS guided staged PCI of complex calcified LCx and branches using Rotational Atherectomy and DES.

[@Kash-r6d]

Thank you for a fresh live case! We really need more of these Dr. Sharma!

[@areenal-taie6836]

Nicely done !
Thank you very much

[@mystery1633]

Great case indeed

[@ramikafa]

Great result. I was worried about the choice of a 1.25 burr with so much tortuosity that it would get stuck but it worked very well.

[@bbagrat]

Greate result! A think that you take 1,5 bur, but what an amazing result by 1,25

[@mahmoud_elrayes]

Excellent case. But only one small note , the topic here is "CCC Live Relay: Complex RA of Severely Calcified Circumflex - December 2023" and also the written content"Case and Plan" while you are working on RCA. Thanks for your highly didactic work.

[@zaidhakim]

Better with 7F AL0.75 and a proper supportive microcatheter like TP spiral

[@jwilson3985]

Couple things off the bat. 6Fr is inadequate, like bringing a Swiss Army knife to a gunfight. Go with 7-8Fr AL .75 or AR1. Fiencross is nothing but a plastic tube. To negotiate this tortuosity a TP LP or Corsair XS pro would be much better.