Complex - Arch 2024

Case and Plan
77 yrs, Male - Presented on 11/13/2023 with progressive angina and DOE due to CAD and severe AS
CAD Risk Factors:
Controlled Hypertension
Controlled hyperlipidemia
CKD s/p renal transplantation x2
H/o Neuro endocrine tumor s/p RT
SAQ-7 score: 60
Clinical Variables
Pt has known AS and normal EF
Medications:
ASA, Atorvastatin, CellCept, Flomax. Renal transplant drugs
Cath: Cath @OSH on 11/13/2023 revealed 2 V CAD (Multiple calcific lesion in LAD involving bifurcation, 60% Ramus), syntax score 16, LVEF 62%, STS risk score 3.2% and severe AS. On 12/5/2023 pt underwent TAVR using 29mm Navitor valve and did well with planned medical management of CAD. Subsequently pt started developing progressive angina for last 1M and while being planned for elective cathPCI, was admitted to OSH with small NSTEMI.
Plan: Now planned for high risk PCI of multiple calcific lesions of LAD/Diagonal via TAVR valve struts using Rotational atherectomy with imaging guidance

[@areenal-taie6836]

Thank you very much
Excellent teaching case ❤

[@wilzboyz]

No 2.75 IVL balloon. Agree no need for IVL. Could probably get away with provisional across the diag.

[@drsen5]

Great

[@jwilson3985]

Why IVL the Diag? Total waste of $. There was superficial Ca and fracture seen with just a SC balloon. Wolverine or NC would do just fine.