Case Video 2. GuideLiner-Assisted Orbital Atherectomy for PCI of Calcific and Tortuous RCA Stenoses

Case 2

A 75-year-old male veteran with coronary artery disease status post three-vessel CABG in 2010 (left internal mammary artery [LIMA]-LAD, saphenous vein graft [SVG]-diagonal, SVG-PDA), chronic diastolic heart failure secondary to ischemic cardiomyopathy with EF of 48%, hypertension, hyperlipidemia, diabetes, peripheral vascular disease, bilateral carotid artery disease, and tobacco use disorder presented to our service with chest pain. He was found to have a non ST-elevation myocardial infarct in 2017. He had previously undergone coronary angiography in 2012, which revealed an atretic LIMA-LAD, a severe anastomotic lesion of the SVG to the small-caliber diagonal, and a completely occluded SVG-PDA graft. He was referred to the interventional cardiology service for repeat coronary angiography, which showed: (1) A LAD CTO that back-filled from the SVG-diagonal; (2) A left circumflex artery CTO that filled distally via collaterals; (3) Severe mid and distal calcified RCA lesions; (4) The known findings described in the 2012 angiography with stable disease. 

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