Abstract 12565: Rotational Atherectomy in the Left Coronary System

Abstract

It′s known that the Left Coronary Artery stenosis has greater mobility and mortality compared to the rest of the coronary tree, due to its size since the formation of plaques has a disseminated distribution, greater volume and severity of calcification. The use of rotational atherectomy (RA) has proven to be an effective tool to facilitate the sub-expansion of stents in atheromatous calcified lesions. We present a case study where plaque modification is performed by atherectomy and angioplasty in the Left Coronary system.A 62 years old female patient diagnosed with diabetes mellitus 2, systemic arterial hypertension and dyslipidemia. Antecedent of coronary angiography 10 days prior to admission due to chest pain and dyspnea, where found trivascular disease of left dominance with diffuse calcified lesion. She was programmed for RA with ROTABLATOR and ROTAWire system. It started by advancing the microcatheter on the angioplasty guide and exchanging for ROTAWIRE 0.009”. Subsequently, the 1.5 mm abrasive bur was advanced, rotating up to 6 times in the proximal and middle segment of the Anterior Descending Artery, proceeding to predilate with balloon noting a non-dilatable distal lesion, a 1.25 mm abrasive bur was passed, rotating up to 3 times, and it was decided to perform balloon predilatation and placement of spliced stents.Continuing with Circumflex Artery, an intermediate 0.014” Zinguer guide was advanced to the distal segment, spliced stents were placed in the proximal segment and it was dilated with a balloon to optimize results. It was decided to exchange guides and predilated the artery ostium, then it was decided to advance the stent using the Culotte bifurcation technique and a proximal optimization of the stent with a balloon was performed.Finally, a post-dilation was performed in the Anterior Descending Artery and the Left Coronary Trunk with a balloon to optimize a successful result (Figure 1), with no dissection image or thrombus. Final flow TIMI 3, TMP 3.