Utilization Of Rotablator And Scoring Ballon In Heavily Calcified And Diffuse Coronary Artery Disease

Author : M.Thein, G. Yoga, M. Munawar
Upload Date : 19-04-2018

Preserving side branches (SB), especially in bifurcation and significant large side branch is usually done by putting a protection wire at the SB. It may cause of arterial injury at the SB. In this series, we report of 4 cases of calcified and diffusely diseased lesion, performing modification plaque by combination of rotablation and scoring balloon. We hypothesize that by using this technique, all visualized side branch may be preserved and it may possibly be protected from side branch occlusion due to shifting plaque. This series include four consecutive patients. There are 3 male and 1 female. Their age between 53 to 81 year-old.  All 4 patients are stable angina pectoris patients, with no history of myocardial infarction, all except one patient had undergone failed POBA attempt, and one has chronic kidney disease, with pacemaker inserted for syncope, and also all of the patients has diabetes mellitus. Three had distal left main (LM) disease, and all had diffuse left anterior descending artery (LAD), and one had right coronary artery (RCA) disease. In our third case FFR study was utilized to identify the target vessel for reperfusion. Rotablation was done using 1.5 and 1.75 burr in all patients and the range of speed between 180,000-190,000 rpm. Scoring balloon was done after rotablation and was started from its size of 2.5 mm and was upsized until 3.5 mm especially for proximal optimization technique (POT). The balloon pressure was applied between 6-14 atm. After all lesion was carefully prepared, the stent was implanted accordingly without putting protection wire. None of visualized side branches were occluded due to shifting plaque. Hence combination of rotablation and scoring balloon is safe and may be used one of the strategies of preventing shifting plaque and therefore preventing the putting of protecting wire at the side branch that may cause unnecessary injuries.

KEYWORDS : Rotablator, Scoring Balloon, Side Branches, Bifurcation lession, Calcified lession.

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