Lots of interesting abstracts and cases were submitted for TCTAP 2026. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge!

CASE20251028_004

From Stonewall to Stent: ELCA as a Bailout Strategy for Rota-Burr Uncrossable Lesion

By Alvin Brilian Budiono, Wei Wang

Presenter

Alvin Brilian Budiono

Authors

Alvin Brilian Budiono¹, Wei Wang²

Affiliation

Primaya Hospital Makassar, Indonesia¹, Wuhan Asia Heart Hospital, China²

View Study Report

CASE20251028_004

Coronary - Complex PCI - Calcified Lesion

From Stonewall to Stent: ELCA as a Bailout Strategy for Rota-Burr Uncrossable Lesion

Alvin Brilian Budiono¹, Wei Wang²

Primaya Hospital Makassar, Indonesia¹, Wuhan Asia Heart Hospital, China²

Clinical Information

Relevant Clinical History and Physical Exam

A 75-year-old male presented with persistent angina since 2-years. He had comordibities of hypertension, type 2 diabetes, and a smoking history. He was recently hospitalized for heart failure with tachyarrhythmia. Medications were fosinopril, furosemide, spironolactone, andrivaroxaban.His BMI is 16.5 kg/m² and vital signs were stable. The presentation indicated a high-risk patient with multiple comorbidities, making complex coronary artery disease the primary concern.

Relevant Test Results Prior to Catheterization

ECG showed Atrial Flutter-Fibrillationwith a complete RBBB. Echocardiography revealed LVEF 50%, biatrial enlargementwith slight thickened in the interventricular septum, mild mitralregurgitation, and severe tricuspid regurgitation. CCTA identified heavilycalcified plaques in LAD, LCX, and RCA.Blood tests showed increased HSTroponin I 350 ng/L, increased NT Pro BNP 1510 pg/ml, normal renal function andsuboptimal glycemic control (HbA1c 6.7%).

Relevant Catheterization Findings

Diagnostic angiography revealed 95%stenosis in mid & distal LAD, 80% stenosis in proximal OM4, and 60%stenosis in distal RCA with calcification.

CAG1.mp4

CAG2.mp4

CAG3.mp4

Interventional Management

Procedural Step

PCI was initiated with prophylactic IABP via a 7Fr EBU 3.5 guide. A guidewire crossed the lesion, but a 2.0/20mm balloon failed. A 1.5/15mm balloon predilated at 16 atm, yet larger balloons remained uncrossable and angiography showed no improvement. The procedure was complicated by chest pain, hypotension, and ST-segment elevation, prompting urgent IABP initiation.Rotational atherectomy was attempted. A Corsair microcatheter failed to cross, so the ROTA wire was advanced manually. A 1.25 mm burr (160,000-200,000 rpm) also failed to cross the lesion.We proceeded with Excimer Laser Coronary Atherectomy (ELCA) using a 0.9mm catheter. Initial runs under blood medium failed. Switching to 1:1 saline : contrast medium proved critical; after 67 seconds of lasting, the lesion was successfully crossed.IVUS revealed a severely compromised lumen (MLA 1.62 mm², plaque burden 79.31%) with >270°calcification and calcium nodule. Subsequent preparation with 2.0/15mm balloons succeeded. Two overlapping DES (2.75/13mm & 3.0/18mm) were implanted and post-dilated. Final IVUS confirmed optimal stent expansion and apposition, with angiography showing TIMI 3 flow.

PRE PCI.mp4

ROTA FAILED.mp4

FINAL VIDEO.mp4

Case Summary

PCI with IABP support faced a balloon-uncrossable lesion. Rotational atherectomy with a 1.25mm burr also failed. Successful lesion crossing was achieved using Excimer Laser (ELCA) with a key technique switch to saline:contrast medium. After IVUS-guided assessment of the severely calcified lesion, two DES were implanted with optimal final results and TIMI 3 flow.

E-Case

CASE20251028_004