The rotational atherectomy with a guide extension catheter for calcified and tortuous lesions in left anterior descending artery: a case report

Background The interventional treatment of calcified lesions with severe tortuosity in the left anterior descending artery (LAD) was challenging and the report of rotational atherectomy with mother-and-child technique has been scarce. Case presentation An 84-year-old woman was hospitalized for non-ST-segment acute coronary syndrome. Coronary angiography revealed a calcified nodule in the LAD. During rotational atherectomy of the calcified and tortuous lesion in the proximal LAD, eccentric cutting due to wire bias nearly caused perforation. The burr seemed to protrude from the contrast media during angiography. Intravascular ultrasound imaging revealed that extremely eccentric ablation almost reached the adventitia. We successfully ablated the distal calcified nodule by preventing proximal overcutting of the tortuous lesion with support from a guide extension catheter, i.e., the mother-and-child technique, followed by the deployment of the drug-eluting stent. The patient was discharged without chest symptoms and no symptom recurred during 12-month follow-up. Conclusion This case demonstrated that safe ablation of a calcified nodule located distal to a tortuous and calcified lesion in the proximal LAD with the mother-and-child technique.

Impact of Serum Lipoprotein (A) Level on Coronary Artery Calcification: An Intravascular Ultrasound Study

Background Plasma lipoprotein(a) [Lp(a)] participates in the development of coronary heart disease (CAD). However, the relationship between Lp(a) level and the characteristic of coronary artery calcification has not been investigated. Methods A total of 123 patients with CAD who underwent percutaneous coronary intervention(PCI) were analyzed.Calcification burden of coronary culprit plaque was measured by the angle and thickness with intravascular ultrasound imaging(IVUS). Patients were divided into 2 groups: low Lp(a) group, < 150mg/L; high Lp(a) group, ≥ 150mg/L. Results Mean patient age was 62.6 ± 10.1years, and 75.6% were men. Among 139 lesions, compared with the high Lp(a) group, the low Lp(a) group had significantly greater median maximum calcification angle (166.4°[102.1, 260.5] vs 118.4° [83.4,169.7], P = 0.007) and thick calcification(40.7% vs 21.2%, P = 0.013).Plaques with a maximum calcification angle of ≥ 180° were more frequently observed in the low Lp(a) group (42.6% vs 18.8%, P = 0.002).The calcification lesions of maximum arc ≥ 180° +thick calcification were larger in the low Lp(a) group (35.2% vs 11.8%, P = 0.001). Multivariate logistic regression analysis showed that low Lp(a) level was a independent predictor of a greater calcification burden: calcification arc ≥ 180°(OR 4.43, 95%CI1.93-10.13;P < 0.001),and thick calcification + maximum calcification arch ≥ 180°(OR 5.92, 95% CI 2.36–14.82; P < 0.001). Conclusion In patients with CAD, Low Lp(a) level was associated with high burden of coronary artery calcification. Our findings might provide a new perspective of Lp(a) level on plaque-stabilizing effects in coronary atherosclerotic plaque.