Chocolate CHIP Intervention Reloaded: Rotational Strikes Back! Videos 5-7

Videos 5-7.

Videos 5-7. Left heart catheterization was repeated and revealed occlusion of the RCA, and severely calcified and hemodynamically significant proximal left anterior descending artery (LAD) coronary artery disease with fractional flow reserve (FFR) of 0.55 and a minimal lumen area (MLA) of 2.7 mm² by intravascular ultrasound (IVUS).

Chocolate CHIP Intervention Reloaded: Rotational Strikes Back!

Rupak Desai, MBBS, Atlanta VA Medical Center, Decatur, Georgia
Orlando Marrero, RCIS, MBA, Tampa, Florida
Bernetta Howard, MSN, CCRN, RN-BC, Cardiac Catheterization Laboratory,
Atlanta VA Medical Center, Decatur, Georgia
Gautam Kumar, MD, Assistant Professor, Division of Cardiology, Emory University/Atlanta VA Medical Center, Atlanta, Georgia 

In this case, we demonstrate that rotational atherectomy with adjunctive Chocolate balloon angioplasty facilitates excellent stent expansion and apposition, and will hopefully decrease the risk of restenosis and thrombosis in this very calcified LAD.

Case: A 69-year-old male presented with fatigue, dyspnea, dizziness, and palpitations after mowing the lawn. Electrocardiogram (ECG) showed slow ventricular tachycardia (VT). He had a similar episode 6 months earlier (thought to be scar VT) that was treated with cardioversion and intensified beta blockade. His past medical history is significant for:

1)    Ischemic cardiomyopathy with an ejection fraction (EF) of 25-30%:

  ‚Ä¢  ICD (implantable cardioverter-defibrillator) implantation in 2001;

  ‚Ä¢ Most recent cardiac catheterization in 2001 revealed an occluded distal right coronary artery (RCA);

  ‚Ä¢  Non-viable inferior/inferolateral walls (with aneurysm, confirmed by cardiac magnetic resonance imaging);

2)     Chronic kidney disease, stage 3A;

3)     Hypertension;

4)     Hyperlipidemia.

Physical examination was unremarkable other than a laterally displaced apex beat at the anterior axillary line.

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