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Ostial RCA

  • Khaled Hammad
  • Khung Keong Yeo
Chapter
Part of the Clinical Cases in Interventional Cardiology book series (CCIC)

Abstract

A 65-year-old female, with a history of hypertension and hyperlipidemia, presented with exertional chest pain. She had CABG in 2013 with the following grafts: LIMA to the LAD and SVG to OM1. Nuclear imaging stress test showed mild ischemia (5%) in the basal inferior wall. The LVEF was 69%. Diagnostic angiography showed severe native triple vessel disease with patent grafts. The RCA had new severe ostial, calcific stenosis (Fig. 5.1a, b, Videos 5.1 and 5.2).

Supplementary material

Video 5.1

This shows the native RCA with the severe calcific ostial stenosis (MP4 6643 kb)

Video 5.2

This shows the native RCA with the severe calcific ostial stenosis (MP4 6613 kb)

Video 5.3

This shows the difficulty in wiring the RCA. The ostial disease and the awkward angle of RCA ostium provided very poor support for wiring. Fortunately, a Fielder wire could be wired into the distal RCA (MP4 11437 kb)

Video 5.4

This shows the difficulty in wiring the RCA. The ostial disease and the awkward angle of RCA ostium provided very poor support for wiring. Fortunately, a Fielder wire could be wired into the distal RCA (MP4 8317 kb)

Video 5.5

This shows rotablation with a 1.25 mm burr with a Rota extra-support wire. The key here is to ensure that the guide is coaxial with the vessel ostium. The use of an extra-support wire also provides a slight advantage in straightening the trajectory of the Rota burr and enhancing coaxial alignment (MP4 11471 kb)

Video 5.6

This shows the Finecross microcatheter crossing easily after rotational atherectomy (MP4 2510 kb)

Video 5.7

Final angiographic appearance of the RCA (MP4 5209 kb)

Video 5.8

Final angiographic appearance of the RCA (MP4 5332 kb)

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of CardiologyNational Heart Centre SingaporeSingaporeSingapore

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