ROTA ABLATION OF LEFT CIRCUMFLEXCORONARY ARTERY WITH SUBCLAVIANARTERIA LUSORIA THROUGH RIGHTRADIAL APPROACH

Dr Sudam Jare

KIMS Hyderabad, India

Case profile

68 years male came with angina on exertion CCS II from 6 months.

Risk factors : long standing diabetes mellitus, hypertension, obesity (wt = 120 kg), dyslipidemia.

Past history : old inferior wall myocardial infarction (1990) with mild LV dysfunction.

Coronary angiograms in 1991 and 1996 in other hospital which revealed single vessel disease (RCA chronic total occlusion) & was on optimal medical management since then.

Physical examination - normal

ECG – q in inferior leads suggestive of old inferior wall MI

ECHO – RWMA in RCA territory, mild LV dysfunction

CT coronary angio. revealed calcified tripple vessel disease with high calcium score.

Mid RCA CTO, PDA &PLVB filling through collaterals retrogradely

LCX-calcified, proximal discrete 90% stenosis

LAD- prox. normal , mid to distal diffuse disease

Arteria Lusoria

Guidecatheter : 6 F 3.5 EBU

Guidecatheter : 6 F 3.5 EBU

Rota wire across lesion

Rota wire across lesion

Rota wire across lesion

1.25 mm Rotalink burr

Post ROTA Angio Shoot

BMW Wire & Rota Wire across lesion

2.5 x 10 mm Balloon

Lesion predilated with 2.5X10 mm balloon at 14 ATM

Post balloon dilatation

Stent 3.5 x 15mm DES

Stent 3.5 x 15mm DES

Stent 3.5 x 15mm DES

Stent 3.5 x 15mm DES

3.5 X 15 mm DES at 13 ATM

Post PTCA /STENT

Post PTCA /STENT

Arteria Lusoria

Arteria Lusoria

Right Subclavian Artery Loop

Final Result

Message

ROTABLATION through radial artery is an attractive alternative to the femoral approach to improve patient comfort and limit access site complications even in presence of subclavian arteria lusoria.