PMC10288993_01
Pictures (A1, B1, C1) were taken with echoPlaque 3.0 (INDEC medical systems, Inc, mountain view, CA). (A) Baseline coronary angiogram. (B) Rotational atherectomy. (C) Failed dilation after 1.5 mm burr. (D) Angiogram after 1.75 mm burr and balloon dilation. (E) shockwave balloon. (F) Post-DES of LAD. (A1) The IVUS showed a 360  loop calcification. (B1) The IVUS imaging after 1.5 mm burr rotation. (C1) The IVUS imaging after 1.75 mm burr rotation. (D1) The OCT imaging showed no calcium fracture after rotational atherectomy procedure. (E1) Over three places of calcium fracture after IVL. (F1) Final OCT post stent.
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F1
CHOL, 2.94 mmol/L; HDL-C, 0.96 mmol/L; and LDL-C, 1.55 mmol/L. Coronary angiography showed approximately 80% stenosis in the proximal mid-segment of the left anterior descending (LAD) artery and approximately 60% stenosis in the opening of the left diagonal artery (Figure 1A). Intravascular ultrasound (Boston Scientific Corporation, Maple Grove, MN) revealed calcification of the anterior descending artery in a 360  loop with a minimum lumen area (MLA) of 2.23 mm2 (Figure 1A1). A 1.5 mm burr of 150,000 r/s was applied to rotablate the LAD artery calcification (Figure 1B), and dilatation (2.75*15 mm NCB, Boston Scientific) was performed at 14 atm (Figure 1B1). The lesion clearly showed a "dog-bone" image (Figure 1C). After a stepped burr strategy with a 1.75 mm burr of 150,000 r/s, 3.0 mm x 12 mm non-compliant balloon (Boston) dilatation was performed (14 atm), and the lumen was enlarged without calcification fracture (Figure 1C1). At this point, the MLA was 2.09 mm2 (Figures 1D, D1). A 3.0 mm shockwave balloon (Shockwave Medical, lnc, Betsy Ross Drive Santa Clara, CA) was applied to the LAD artery lesion (Figure 1E) at 6 atm with 40 pulses from far to near. Optical coherence tomography (Abbott Vascular, Santa Clara, CA, USA) showed a maximum fracture depth of 0.98 mm and an MLA of 2.77 mm2 (Figure 1E1). Finally, a drug-eluting stent (Boston Scientific) measuring 2.75 mm x 32 mm was implanted smoothly with a minimum stent area (MSA) of 5.51 mm2 and stent expansion rate of 84% (Figure 1F1).
Tissue and lumen display mode, pictures (A-C) were taken with echoPlaque 3.0, pictures (D) and (E) showed longitudinal and 3D OCT views.
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F2
Longitudinal reconstruction images showed the entire percutaneous coronary intervention procedure (Figure 2).