case_images: PMC11775797_01
case_images: Coronary Angiography and Intravascular Imaging. (A) Baseline coronary angiography showing severe calcific disease in the distal left main stem and proximal left circumflex. (B) Intravascular ultrasound image demonstrating protruding calcific nodule at the ostium of the left circumflex. (C) Postintervention coronary angiography. (D) Postintervention intravascular ultrasound of well-expanded stent at the site of the nodule. (E) Coronary angiography following presentation with recurrent acute coronary syndrome. (F) Optical coherence topography following predilation demonstrates calcific nodule protruding through the stent in the distal left main stem. (G) Coronary angiogram following rotational atherectomy and treatment with drug-coated balloon. (H) Postintervention OCT showing successful ablation of the nodule and dissection within the neointimal tissue.
case_images: gr1.jpg
case_images: PMC11775797_01_gr1.jpg
case_images: fig1
case_images: The left main stem (LMS) and left circumflex (LCx) arteries had severe calcific stenosis (Figure 1A, Video 1). Impella (Abiomed) support. Intravascular ultrasound showed nodular calcification at the ostial LCx (Figure 1B, Video 2) which was modified with intravascular lithotripsy. A 3.0-mm drug-eluting stent was placed in the mid to distal LCx and overlapped proximally with a 3.5-mm drug-eluting stent in a provisional manner to the LMS ostium (Figure 1C). Intravascular ultrasound confirmed an eccentric but well expanded stent with a minimal stent area (MSA) of 7.4 mm2 in the ostial LCx (Figure 1D, Video 4).