Case and Plan
85 yrs, M with PAD but no CAD
Presented with new onset CCS class I angina & SPECT MPI revealing multi-vessel ischemia
CAD Risk Factors
Hypertension- controlled
Hyperlipidemia- controlled
IRDM- Controlled
Afib on NOAC, Asthma (on 3 inhalers)
SAQ-7: 72. PAD s/p PTAs
Clinical Variables
No prior CAD history, active, exerciser, normal EF on echo
Cath: Cath on October 30th 2023 revealed calcific 3 V CAD; 95% pLAD with 70% dLAD, 90% calcified LCx, multiple 80-90% calcified RCA lesions, LVEF 60% & Syntax score 38. After heart team discussion, CABG declined and pt underwent RotaDES to LAD lesions.
Plan: Now planned for high-risk IVUS guided complex PCI of multiple calcified lesions in a tortuous RCA using Rotational atherectomy.