OCT Guided PCI of Calcified LAD Bifurcation Using 2-Stent Approach and Orbital Atherectomy

67-year-old male with controlled NIDDM presented with CCS Class I angina and positive stress echo for multi vessel ischemia. A cardiac cath four month prior revealed three-vessel coronary artery disease: 80% calcified LAD/D2 bifurcation, 70% distal LAD, CTO mid RCA and CTO proximal LCx, SYNTAX Score of 38 with moderate systolic LV dysfunction. After a Heart Team discussion patient declined CABG and underwent high-risk multi staged PCI of all three vessels for complete revascularization. Patient initially underwent successful PCI of the LCx followed by a PCI of RCA. The case describes LAD/D2 bifurcation intervention using dedicated 2-stent technique after orbital atherectomy and OCT guidance.

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All Authors: Samin K. Sharma, MD, MSCAI; Annapoorna S. Kini, MD; and Sameer Mehta, MD, MBA.

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