ORBITAL ATHERECTOMY ASSISTED OCT GUIDED CHIP PCI
Presenter
Radhapriya Yalamanchi, MBBS, DNB Cardiology, Apollo Hospitals, Chennai, TN, India
Radhapriya Yalamanchi, MBBS, DNB Cardiology, Apollo Hospitals, Chennai, TN, India and Refai Showkathali, MRCP(UK)FRCP(LON)FESC, FACC, APOLLO MAIN HOSPITAL, CHENNAI, TN, India
Title
ORBITAL ATHERECTOMY ASSISTED OCT GUIDED CHIP PCI
Introduction
66 Year old gentleman, diabetic for 30 years, hypertensive on medication, presented with effort angina for 3 months. He underwent coronary angiogram at local hospital which showed calcific severe proximal LAD disease, critical calcific proximal RCA disease and was advised CABG. His echocardiogram showed hypokinesia of anterior and inferior wall with LVEF - 45%.
Clinical Case
CHIP PCI done via RRA. 6F EBU 3.5 GC to engage LMCA. Viperwire with flex tip to cross the LAD lesion. OCT pull back which showed 360 degree calcium with MLA of 1.1 sq mm.1.25mm diamond burr used for atherectomy followed by sequential predilatation with 3mm NC balloon and deployed 3x50mm DES. OCT showed well apposed stent. Following this RCA PCI was performed
Discussion
- Coronary calcification should be anticipated in elderly, CKD and long standing DM patients to plan the strategy prior to PCI.
- Nodular appearing calcium in large sized vessel is an indication for Orbital atherectomy(ideal patient).
- Viper wire is a 0.012/0.014 wire and can be easily manipulated and is flexible compared to Rota wire.
- Stenting can be done over the same wire and avoids wire exchange.