1. Cutting Edge Case Presentation #1
H Tam Truong, MD
Southern Arizona VA Healthcare System

2. Disclosure
H Tam Truong, MD
I have no relevant financial relationships

3. History
69 year old man who has progressive typical angina for the past month referred for coronary angiogram. PMH: DM2, dyslipidemia, hypertension, obesity BMI 40, BPH Echo: EF 60%, no significant valvular disease

4. Coronary Angiogram

5. Zoomed in

6. PCI
Anticoagulation with heparin. Wire: BMW Elite 0.014”

7. Pre-Dilate (Semi-compliant balloon 2.5 x 12 mm to 12 atm)

8. Stent DES 3.0 x 15 mm to 25 atm

9. Post-dilation NC Balloon to 30 atm

10. What’s next? “It’ll be OK”. Use bigger balloon to post-dilate?
Call cardiac surgery for 1V CABG
Rotational atherectomy
Other?

11. Laser with contrast
Half-half contrast, 4 runs, 40 Hz x 40 J/mm2 fluency

12. Balloon post Laser – 16 atm

13. Final

14. Take Home Points Stent Regret
Avoidance approach
make sure lesion is dilatable and prepped prior to stenting (esp at the VA where calcified lesions are common) – may need atherectomy
Laser with contrast is feasible
Rotational atherectomy is feasible
?Distal embolization
4. Further research needed