2019 Scientific Sessions

Title: The Main Course: Treatment of a heavily calcified left main bifurcation lesion and left circumflex CTO. Introduction: A severe, heavily calcified left main stenosis and LCx CTO is treated percutaneously in a patient turned down for bypass. Impella support was used. This case will demonstrate crossing a LCx CTO at a difficult angulation through a severe left main stenosis as well as stent passage once it is crossed. This case demonstrates a bifurcation strategy for the distal left main, LCx, and LAD. This case also demonstrates treatment of a heavily calcified, severe and eccentric left main stenosis without the use of atherectomy. Clinical Case: This is a 74 y.o. man admitted with decompensated heart failure and cardiogenic shock in the setting of an NSTEMI who was found to have a severe, heavily calcified left main stenosis as well as LCx CTO. He had a severely reduced EF and moderate aortic stenosis. He was turned down for bypass surgery and had recurrent episodes of recurrent VT while on IABP support prior to the procedure. Discussion: This case demonstrates the utility of percutaneous hemodynamic support with Impella, crossing an angulated CTO of the LCx in the setting of severe left main stenosis using a Supercross microcatheter, distal left main bifurcation stent strategy, and successful treatment of a severe and heavily calcified eccentric plaque without atherectomy.