Excerpt

A 73-year-old male who complained a typical effort angina underwent percutaneous coronary intervention for severe stenosis with eccentric calcified plaque in the mid-left anterior descending (LAD) artery (Fig. 1a). Optical coherence tomography (OCT) after pre-dilatation with a 2.5 mm semi-compliant balloon catheter showed distribution of calcified nodule around the lesion. Balloon inflation caused coronary dissection (Fig. 1b), which spread behind the calcified nodule, and the guidewire slipped into the cleft in the distal segment of the lesion (Fig. 1c). On the other hand, no major modification in the calcified nodule was induced around the proximal segment of the lesion (Fig. 1d). We added balloon dilatation with a 2.5 mm scoring balloon catheter (NSE PTA; GOODMAN Co., Ltd., Aichi, Japan) at rated burst pressure several times for further modification in the proximal segment of the lesion. Next, when we implanted a drug-eluting stent, coronary perforation occurred at the distal segment of the lesion with coronary dissection (Fig. 1e). OCT showed moderate expansion of the dissected lumen at the point of perforation (Fig. 1f), contrary to less expansion of the stent around the proximal segment of the lesion (Fig. 1g). Coronary perforation was successfully treated with a long-time inflation of a perfusion balloon catheter (Fig. 1h). Ordinary dual antiplatelet therapy was prescribed and he has been uneventful after this procedure.

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