The patient is a 93-year-old male with hypertension, hyperlipidemia, permanent pacemaker, and coronary artery disease with prior PCI with stenting to the proximal LAD, atrial fibrillation, and severe symptomatic aortic stenosis with peak/mean gradient of 52/32 mmHg and aortic valve area of 0.6 cm2. He was previously functionally active and had developed angina and exertional dyspnea. Pre-transcatheter aortic valve replacement (TAVR) evaluation with cardiac catheterization showed a critical calcified mid-LAD lesion (Fig. 7.1 and Video 7.1). Cardiac surgery determined the patient to be inoperable. Following Heart team evaluation, it was decided to proceed with PCI in order to facilitate TAVR.
Baseline LAD lesion. A highly calcified lesion is appreciated in the proximal and mid-LAD (MOV 2317 kb)
Rotational atherectomy with a 1.5 mm burr was performed on the LAD lesion resulting in a dissection and hemodynamic compromise (MOV 4721 kb)
Final result. Four bare metal stents were deployed sealing the dissection with good angiographic result (MOV 4147 kb)