Case Presentation: PCI and Calcified Coronary Artery Lesions
Marco S Shaker, MD, MS, University of Illinois at Chicago, Chicago, IL
Marco S Shaker, MD, MS, University of Illinois at Chicago, Chicago, IL
Keywords: Coronary, Drug-eluting Stent (DES), Hemodynamic Support, Intravascular Lithotripsy (IVL) and TAVI/TAVR/Aortic Valve
Title:
PCI and calcified coronary artery lesion.
Introduction:
Calcified coronary lesions increases interventional challenges and is associated with worse outcomes. Coronary intravascular lithotripsy is a balloon-based modality for treating calcified disease with deep circumferential calcification
Clinical Case:
A 74 y/o female with PMH of HTN, HLD, CVA, PAD, DVT post-IVC filter, and Lung cancer presented to our outpatient clinic for cardiac evaluation before possible surgical resection of RLL mass.
Summary of the case findings: 1. Severe symptomatic aortic stenosis. 2. Complex coronary artery disease including LM 3. LAD aneurysm 4. Extreme surgical risk 5. Severe PAD Stages of treatment: 1) Balloon aortic valvuloplasty (BAV) and Impella placement 2) PCI of LM to LAD 3) LAD aneurysm coiling 4) TAVR Discussion:
Treatment modalities include balloon-based methods and ablative methods. Ablative methods include atherectomy with either rotational or orbital atherectomy and excimer laser. Balloon-based methods include scoring and cutting balloons along with super high-pressure balloons. Balloon based methods have the advantage of ease of use and are useful in luminal calcification. However, all balloon-based methods are limited by crossability of the balloon.