ABSTRACT
This case (slides 1-8 ( frames 1-23)) illustrates a lesion involving the proximal LAD and extending in the mid part of the vessel. The distal left main is free from disease, and the circumflex has a borderline lesion in the distal part ( frame 1). Frame 2 shows the lesion extending towards the proximal and mid LAD. The baseline IVUS assessment shows soft plaque in the proximal part of the lesion and fibro-calcific plaque in the most distal segment (illustrated in frames 3-5). The initial approach was to debulk partially this lesion with significant amount of plaque in order to allow optimal stent expansion. This procedure was also done to minimize possible plaque shift towards the circumflex. The device utilized was a large Silverhawk device (Foxhollow), compatible with the 8-Fr guide-catheter ( frame 8). The result after atherectomy treatment shows a fair result in the proximal part with persistent stenosis in the distal part of the lesion. This stenosis corresponds to the area with fibro-calcific deposits at the IVUS evaluation. For this reason, cutting balloon dilatation was performed ( frame 11), and then the atherectomy device could be advanced at that level. The final result was significantly better than before cutting balloon dilatation, and several atherectomy specimens were retrieved ( frame 14).
