Lots of interesting abstracts and cases were submitted for TCTAP 2024. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-018
Goodbye Calcium: Combining Rotational and Orbital Atherectomy
By Bernard Wong
Presenter
Bernard Wong
Authors
Bernard Wong1
Affiliation
North Shore Hospital, New Zealand1,
View Study Report
TCTAP C-018
Coronary - Adjunctive Procedures (Thrombectomy, Atherectomy, Special Balloons)
Goodbye Calcium: Combining Rotational and Orbital Atherectomy
Bernard Wong1
North Shore Hospital, New Zealand1,
Clinical Information
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
A 78 year old man presented with a three month history of worsening chest discomfort and shortness of beath on exertion. An exercise stress ECG in 2012 was positive, but patient opted for medical therapy.
Relevant Test Results Prior to Catheterization
CT coronary angiogram in late 2022 showed severe calcified stenosis of the mid left anterior descending artery (LAD), with mild to moderate disease in the distal left main coronary artery (LMCA) and proximal LAD.
Relevant Catheterization Findings
Coronary angiogram revealed mild disease in the right coronary artery (RCA) and left circumflex artery (LCX). There was a severely calcified subtotal occlusion in the mid LAD with TIMI 2 flow. The distal LMCA and proximal LAD also had diffuse calcified disease.
Interventional Management
Procedural Step
PCI was performed with a 7F EBU guide from the right radial artery. After the LAD was wired with a Runthrough with Corsair pro XS, the microcather and small CTO balloons could not cross the lesion even with trapliner support and balloon assisted microdissection. The LAD was then wired with a Rotawire Floppy and several runs of rotational atherectomy was performed with a 1.25mm burr at 180,000rpm. Due to the eccentrically calcified stenosis in the distal LMCA/proximal LAD, we changed for a Viperwire and performed predominantly reverse Orbital Atherectomy runs both at low and high speeds to use the wire bias to modificy the calcium. After balloon predilation, OCT was performed, showing excellent calcium modification. Two overlapping drug eluting stents were deployed in the LAD back to the LMCA. Post dilatation, kissing balloon inflation and final POT was performed, with good final OCT and angiographic results.
Case Summary
This case shows the combined use of rotational and orbital atherectomy to tackle a compelx case. It highlights specific situations where one device is preferable over the other. Rotational atherectomy was used in an balloon/microcatheter uncrossable lesion, and orbital atherectomy was used to perform reverse runs in the larger vessel with eccentric calcium. Familiarity with these devices, plus the use of intravascular imaging in complex cases involving severe calcification will improve procedural success.