Patient Education Cardiac Specialist Centre
6. Severely calcified Left Main disease requiring rotablation
This talk was presented on 6/6/2015 in Bangkok at a focus group conference organised by Boston Scientific titled Master the Complex

Baseline angiogram
Heavily calcified distal left main
Previous stent in LCx and LAD


The cranial views
Shows the calcium and the previous stents


1st attempt at pre-dilatation
3.0 x 15 balloon up to max pressure


Ostium LAD

Ostium LCx

Distal LM


Further dilatation
NC 4.0 balloon along LAD and LM to max pressure


What to do next?
LM shows dissection after aggressive pre-dilatation but calcium has not cracked


Weighing options

  • Give up and go for medical therapy
  • Call surgeon
  • Rotablation
    • Which one 1st?
    • What to do with LCx?
    • If I rota LAD, would I lose LCx?


Stent LCx first
3.0 x 12 Stent in LCx ostium


Rotablation of Left Main

  • Felt safe to remove LCx wire
  • 1.75 burr down LM/LAD


After the rotablation
The plaque has been modified LM looks presentable and LCx uncompromised


LM stent
3.0 x 33 stent placed from LM ostium


Final kissing and NC dilatation
NC 4.0 balloon in LAD, NC 3.0 balloon in LCx


Final IVUS
LAD carina

Distal Left Main


Final angiogram
RAO cranial and AP caudal views


Final Compare

Know Your Cardiologists

I feel breathless when walking.

I feel a tightness over my chest.

Do I need to take my medicine for my blood pressure?

Do I need to take my medicine for my cholesterol?

Do I really need stents for my artery?

Do I really need to have a bypass operation?

When should I go for health screening?

I have heart problem, can I take Viagra?

I have heart problem, should I exercise?

Heart Disease
Learn about your heart Conditions

You may need an ultra sound scan of your heart to assess its function.

You may need a treadmill stress test.

You may need closer monitoring.

You may need a more thorough risk assessment and life style change.

You may only need to take your medicine.

You may get away with just stenting.

This generally should start at 40 years old.

Yes, but there are certain strict conditions to fulfill.

Yes, but you will need to find out the appropriate intensity.