Overview
Dr. Jeff Chambers treated a calcified left anterior descending (LAD) and first diagonal branch using orbital atherectomy.
Patient History
The patient is a 77-year-old male who had stenting of a severe lesion in the proximal right coronary artery (RCA) one month prior for unstable angina. He had a severe calcified left anterior descending (LAD) artery at that time, which was managed medically. He continued to have had chest pressure on double antianginal therapy and an Adenosine Cardiolite demonstrated anterior ischemia. The patient’s medical history included hypertension, hyperlipidemia, borderline diabetesand hypothyroidism. He was referred for intervention of the LAD and first diagonal branch.
Treatment Summary
Angiography and intravascular ultrasound (IVUS) demonstrated severe calcification on both sides of the arterial wall. The LAD was severely diseased in the mid-LAD, as was the ostium and proximal portion of the diagonal branch.
Given the amount of severe calcification, it was decided to treat the lesion with orbital atherectomy. The universal wire in place for the IVUS was replaced with a ViperWire Advance® Coronary Guide Wire. Orbital atherectomy was performed with two passes on low speed (80 kRPM) and three passes on high speed (120 kRPM).
Using a universal guide wire, the diagonal was pre-dilated with a 2.5 x 12 balloon. A 2.5 x 20 stent was then placed, which was deployed at 12 atm. Both the proximal ostial lesion and the mid lesion and had a good angiographic result. It was determined that the LAD could be directly stented as the IVUS showed modified plaque and vessel compliance a reduction in the arc of calcium. A 3.5 x 30mm stent was placed. The vessel was post-dilated with a 3.75 balloon at 16 atm. A universal wire was then placed in the diagonal and the procedure was completed with a kissing balloon angioplasty using a 2.25 x 12 NC balloon in the first diagonal and a 3.5 x 12 NC balloon in the LAD, both balloons at 12 atm. Excellent angiographic results were achieved.
Key Takeaways
A calculated approach to device selection is necessary in the treatment of complex coronary disease
Intravascular imaging was essential to assess the lesion, which resulted in the determination that atherectomy was necessary for adequate vessel preparation, enabling successful stent deployment.
Successful revascularization of the LAD and diagonal branch were accomplished using the Diamondback 360® Coronary Orbital Atherectomy System.
Case Study At a Glance
Category
CSI Device
Image Gallery
Pre-Procedure
×
![]()
Pre-Procedure
Post-Procedure
×
![]()
Post-Procedure
Post-Procedure
×
![]()
Post-Procedure
Indications and Important Safety Information
ViperWire Advance® and ViperWire Advance® with Flex Tip Coronary Guide Wires
Indications Statement: The Diamondback 360® Coronary Orbital Atherectomy System (OAS) is a percutaneous orbital atherectomy system indicated to facilitate stent delivery in patients with coronary artery disease (CAD) who are acceptable candidates for PTCA or stenting due to de novo, severely calcified coronary artery lesions.
Contraindications: The OAS is contraindicated when the ViperWire Advance® Coronary Guide Wire cannot pass across the coronary lesion or the target lesion is within a bypass graft or stent. The OAS is contraindicated when the patient is not an appropriate candidate for bypass surgery, angioplasty, or atherectomy therapy, or has angiographic evidence of thrombus, or has only one open vessel, or has angiographic evidence of significant dissection at the treatment site and for women who are pregnant or children.
Warnings/Precautions: Performing treatment in excessively tortuous vessels or bifurcations may result in vessel damage; The OAS was only evaluated in severely calcified lesions, A temporary pacing lead may be necessary when treating lesions in the right coronary and circumflex arteries; On-site surgical back-up should be included as a clinical consideration; Use in patients with an ejection fraction (EF) of less than 25% has not been evaluated.
See the instructions for use before performing Diamondback 360 Coronary Orbital Atherectomy System procedures for detailed information regarding the procedure, indications, contraindications, warnings, precautions, and potential adverse events.
Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.
Diamondback 360® Coronary Orbital Atherectomy System
Indications Statement: The Diamondback 360® Coronary Orbital Atherectomy System (OAS) is a percutaneous orbital atherectomy system indicated to facilitate stent delivery in patients with coronary artery disease (CAD) who are acceptable candidates for PTCA or stenting due to de novo, severely calcified coronary artery lesions.
Contraindications: The OAS is contraindicated when the ViperWire Advance® Coronary Guide Wire cannot pass across the coronary lesion or the target lesion is within a bypass graft or stent. The OAS is contraindicated when the patient is not an appropriate candidate for bypass surgery, angioplasty, or atherectomy therapy, or has angiographic evidence of thrombus, or has only one open vessel, or has angiographic evidence of significant dissection at the treatment site and for women who are pregnant or children.
Warnings/Precautions: Performing treatment in excessively tortuous vessels or bifurcations may result in vessel damage; The OAS was only evaluated in severely calcified lesions, A temporary pacing lead may be necessary when treating lesions in the right coronary and circumflex arteries; On-site surgical back-up should be included as a clinical consideration; Use in patients with an ejection fraction (EF) of less than 25% has not been evaluated.
See the instructions for use before performing Diamondback 360 Coronary Orbital Atherectomy System procedures for detailed information regarding the procedure, indications, contraindications, warnings, precautions, and potential adverse events.
Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.
Results may vary.
Suggestions on case studies offered by the physician are based on their experience using the Diamondback® Orbital Atherectomy System and are their opinion. Medical decisions for your patients are to be based upon their condition and your medical judgment. CSI does not recommend or endorse any particular course of treatment or medical choice. Before using any medical device, including those demonstrated or referenced in this case study, review all relevant Instructions for Use, with particular attention to the indications, contraindications, warnings and precautions, and steps for use of the device.
Boost your CSIQ®
Educational opportunities for physicians
CSIQ is the official professional education program of CSI.
-
Comprehensive courses taught by leading orbital atherectomy experts
-
Personalized, one-on-one proctorships
-
National courses
Printed from https://csi360.com/case-studies/treatment-of-lad-first-diagonal-branch/ on 04/18/2024
©2017 - Present, Cardiovascular Systems, In c. All rights reserved. EN-6210
