A 77-year-old male patient presented with chest pain and associated radiation to the left arm with exertion concerning for unstable angina. He had a stress test concerning for inferior ischemia and underwent cardiac catheterization. He underwent PCI of the RCA as the culprit vessel for his unstable angina; however, he was found to have significant calcified stenosis of the LAD/Diagonal.
Physiologic assessment in the form of RFR was hemodynamically significant in the LAD distribution at 0.87. RFR of the diagonal was not hemodynamically significant. He was scheduled for staged intervention of the LAD with intravascular imaging and potential atherectomy. Intravascular imaging of the LAD showed a heavily calcified stenosis; the arc of calcium was greater than 180º, thickness greater than 0.5 mm and a length of calcium greater than 5 mm.
Based on the OCT-based calcium scoring system, this patient would score 4 out of 4 points. Without appropriate calcium modification, there is significant concern for stent under expansion and ultimately poor long-term outcomes.