Initial intravascular imaging was attempted with an OCT catheter; however, it would not pass through the calcified mid LAD lesion. Due to presence of calcium noted on angiography and the inability to pass an imaging catheter, orbital atherectomy was performed of the LAD.
Post-orbital atherectomy, intravascular imaging was performed with OCT. This revealed calcified nodular disruption in the mid LAD. The eccentric calcified nodule was appropriately modified in this case by the unique orbital action of the crown.
Post-stent deployment, due to appropriate plaque modification, stent delivery was not an issue and excellent stent expansion was observed.