Left femoral vascular access was obtained using ultrasound imaging guidance. A 6F JL4.0 guide catheter was used. Intervention was performed on the left circumflex artery (LCX) first. The LCX that was crossed was first treated with drug-eluting stents (DES).

The left anterior descending artery (LAD) was severely calcified, and it was difficult to cross the lesion. Support from a microcatheter was required. The 0.014″ guidewire was subsequently exchanged out for Rota extra-support wire. Rotational atherectomy was performed sequentially at the proximal and mid LAD with 1.25 mm burr at 150,000 rpm (Figs. 20.5 and 20.6 and Videos 20.5 and 20.6). Adequate lesion preparation was then achieved during predilation with a semi-compliant 2.0 × 15 mm balloon. Two DES (2.25 × 38 mm and 2.5 × 38 mm) were first deployed from the distal to mid LAD, respectively. The left main (LM) to proximal LAD was stented with two DES (3.0 × 38 mm and 3.5 × 8 mm) and post-dilated with 3.5 × 15 mm NC balloon. Good angiographic result was achieved (Fig. 20.7; Figs. 20.8, 20.9 and 20.10; Videos 20.7, 20.8, 20.9 and 20.10).