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Specials: Rotablation Through Stent Accordion

  • Khung Keong Yeo
  • Garrett Wong
  • Reginald Low
Chapter
Part of the Clinical Cases in Interventional Cardiology book series (CCIC)

Abstract

A 52-year-old man presented with NSTEMI. He had diabetes mellitus, hypertension, dyslipidemia, prior tobacco, and heavy alcohol use. He had a past history of CAD with CABG 3 years ago with LIMA to LAD, SVG to first diagonal, SVG to OM1, SVG to circumflex, and SVG to RCA. His LVEF was 35%. Coronary angiography showed severe native three-vessel disease, patent LIMA graft to the LAD, occluded SVGs to the OM1, RCA, and circumflex and severe stenosis in the SVG to the diagonal (Fig. 25.1, Videos 25.1 and 25.2) We proceed to intervene on the SVG-diagonal lesion.

Supplementary material

Video 25.1

These show the SVG-diagonal lesions (MOV 1892 kb) (MOV 1892 kb)

Video 25.2

These show the SVG-diagonal lesions (MOV 1892 kb)

Video 25.3

This shows deployment of the spider filter (MOV 1957 kb)

Video 25.4

This shows deployment of the stents and angiogram after stenting (MOV 1898 kb)

Video 25.5

This shows deployment of the stents and angiogram after stenting (MOV 1223 kb)

Video 25.6

This shows the difficulty in delivering the 2.5 × 12 NC balloon with the guide being pushed back into the aorta and the filter wire being pulled against the distal stent edge (MOV 834 kb)

Video 25.7

This shows the deformation of the distal stent edge by the filter (MOV 996 kb)

Video 25.8

This shows the attempted retrieval of the filter wire. It was thought that the retrieval catheter would push the filter away from the stent edge (MOV 908 kb)

Video 25.9

This shows the filter crumpling the stents proximally as the filter was pulled proximally via the retrieval catheter (MOV 1185 kb)

Video 25.10

This shows close-up the crumpled (“accordioned”) stents (MOV 2334 kb)

Video 25.11

These show the careful, gentle rotablation technique, with great care taken not to aggressively push the burr through the stents (MOV 1609 kb)

Video 25.12

These show the careful, gentle rotablation technique, with great care taken not to aggressively push the burr through the stents (MOV 1158 kb)

Video 25.13

Final angiogram (MOV 2133 kb)

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of Cardiovascular MedicineUniversity of California, Davis Medical CentreSacramentoUSA

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