Imaging Guided RotaTripsy DES of Large Calcific Nodule in Distal LM/LCx

Case Plan
72-year-old obese female with crescendo angina and dyspnea was found to have severe AS on echo. A Cardiac Cath on April 9, 2024 revealed calcific 3V + LM CAD with large calcific nodule of distal left main, SYNTAX Score of 44 and EF 55%. Patient underwent CABG (LIMA for LAD, RIMA to Diagonal) and bioprosthetic SAVR and subsequently did well. Additional bypasses could not be done due to calcific aorta (‘Eggshell’). Patient continued to remain symptomatic with CCS Class II angina and DOE. Patient is now planned for imaging guided RotaTripsy DES intervention of residual large calcific nodule in distal LM/LCx.

[@areenal-taie6836]

Thank you

[@tom11298]

LM-LAD supplied via lima
Ptca of ostial lad has big chance of recoil/dissection soon..
Before seeing the final shot, my expectations of the above sentence did happen
lima is doing the job, all good.
I would habe only stented lima-Lcx

[@wilzboyz]

Aminophyline ideally 5-10m beforehand. Short 5-10s runs. Rarely need TVP

[@tom11298]

IVL is good enough alone. IVL would have been more gentle in terms of Brady

[@jwilson3985]

Good rota technique. With sub-totaled RCA would have used meds/TVP up front. Liberal use of IC Nipride/Cardene before runs may help? Also would open that RCA in near future.