Complex Case: Rotational Atherectomy Involving the Left Main Coronary Artery
An 88-year-old man with high-risk NSTEMI was referred for angiography. He was found to have critical left main disease with a 99 % stenosis involving the proximal left anterior descending (LAD) artery and the proximal circumflex (LCX) stenosis consistent with Medina 1,1,1. Due to his co-morbid conditions, he was ultimately turned down for surgical intervention, and referred for PCI. He underwent successful interventional under ECMO support of the left main, proximal LAD and left circumflex coronary arteries, illustrating an example of complex and high-risk PCI involving bifurcation disease.
Ellis type I vessel perforation of the left circumflex post-rotational atherectomy, white circle illustrating extravasation of contrast material outside of vessel wall that is not free flowing but rather contained within a cap (WMV 16145 kb)