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
IVUS of LAD/LCx/LM
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
- Give up and go for medical therapy
- Call surgeon
- 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
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
Distal Left Main
RAO cranial and AP caudal views