77 year-old male with stable class II angina and exertional dyspnea was noted to have calcified 90-95% left internal carotid artery stenosis on carotid duplex for ongoing neurological symptoms. A cardiac cath performed as a part of pre-op evaluation for carotid endarterectomy revealed calcified severe two-vessel (RCA and LCx) and 90% distal LM disease with SYNTAX score of 26, LVEF of 60% and moderate AS. After Heart Team discussion, CABG was declined due to ongoing neurological issues and moderate AS and PCI was recommended. The case presents IVUS guided high risk PCI of calcified distal LM using rotational atherectomy and single crossover stent approach. The case is accompanied by an interactive discussion of the 5-years outcomes for the EXCEL trial.
From CCC Live Cases
All Authors: Samin K. Sharma, MD, MSCAI; Annapoorna S. Kini, MD; and Sameer Mehta, MD, MBA.
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