case_images: PMC8123955_01
case_images: Electrocardiogram showed ST-segment elevation in anterior leads with right bundle-branch block pattern.
case_images: IMCRJ-14-289-g0001.jpg
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case_images: ST-segment elevation in anterior leads with right bundle-branch block (RBBB) (Figure 1). Subsequently, the patient underwent an emergency cardiac catheterization.
case_images: (A) Total occlusion at proximal segment of left anterior descending artery from coronary angiography pre-primary PCI (arrow); (B) final result after primary PCI showing significant residual stenosis at proximal left anterior descending artery (arrow).
case_images: IMCRJ-14-289-g0002.jpg
case_images: PMC8123955_01_IMCRJ-14-289-g0002.jpg
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case_images: Diagnostic coronary angiography demonstrated a total occlusion at the proximal left anterior descending (LAD) artery with suspected severely calcified lesion due to its dense radiopacity (Figure 2A). The flow to distal LAD was restored with TIMI-2 flow; however, leaving 90% residual stenosis at the primary lesion (Figure 2B).
case_images: (A) Baseline cine pre-second PCI showing significant residual stenosis (arrow); (B) Rota burr 1.75 was used to modify residual stenosis; (C) modified lesion after rotational atherectomy before stenting (arrow); (D) final result of second PCI (after stenting).
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case_images: PMC8123955_01_IMCRJ-14-289-g0003.jpg
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case_images: Angiography evaluation revealed the residual stenosis at main LAD lesion (Figure 3A). Rota Wire 0.009" (Boston Scientific Corp., MA). Rota burr 1.75 (Boston Scientific Corp., MA) was used and RA was completed in modifying the calcified lesion with five subsequent pecking-motion runs at 160,0000-215,000 rpm for 8-10 seconds (Figure 3B). A bigger balloon, NC Sprinter 3.0 (Medtronic Corp., Minneapolis, MN), was used to dilate before drug-eluting stents (DES) were placed (Figure 3C). Final angiography after several stents were placed showed no residual stenosis, (Figure 3D) and no complication was observed during and after the procedure.