Learn From The Masters - Managing Calcified Bifurcation Coronary Lesions (June 2024)

Patient Demographics
78 yrs, M CAD Risk Factors
Hypertension- controlled
Hyperlipidemia- controlled
NIDDM- controlled
Present Clinical Presentation
Presented with CCS class Il angina, CTA revealing
LAD and RCA disease and stress MPI for inferior and apico-lateral ischemia
Clinical Variables
Known CAD s/p DES PCI of D1 and PL 2011, EF 60%
SAQ-7: 79
Medications
Aspirin, Losartan, Amlodipine, Metoprolol XL, Rosuvastatin, Ezetimibe, Glucophage, Glimepiride
Cath: Cath on June 4th 2024 revealed calcific 3 V CAD with ISR; 80-90% multiple RCA lesions, 80% LPL DES ISR, 70-80% calcified bifurcation LAD/D1 (1,1,0) with FFR 0.76, LVEF 50% & Syntax score 22. Pt underwent RotaSynergyDES of RCA/LPL & did well.

[@jwilson3985]

Or rota LAD then Diag before performing plasty. Either way is better than the method chosen imo. But excellent case.

[@uzunoglan.sezgin]

Can we do side branch DCB arter main branch stenting because if there is dissection taking pictures could make dissection worse.

[@MuhammadYasir-jl2fm]

I would have done it differently. Stent the LAD and kissing balloon inflation with NC balloons followed by DEB to diagonal and kBI again with NC in LAD and same DEB in diagonal

[@uzunoglan.sezgin]

Do you think you can achieve the same result without rotablation?
Second question is Annu back the side branch rotawire after rotational atherectomy, WhatsApp will happened if there is rota related rupture? İsnt it possible?

[@jwilson3985]

Would have been better to rota LAD into Diag first, LAD second, then do CBPTCA and DCB.

[@Whenisaybum]

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