Vadodara: A 69-year-old patient with acute coronary syndrome and kidney dysfunction has successfully undergone a complex angioplasty using advanced rotablation technology at a city-based hospital.The patient was admitted to the intensive care unit (ICU) with chest pain while walking, eating and passing stool. Coronary angiography revealed a severely calcified blockage at the origin of the left anterior descending (LAD) artery, one of the major blood vessels supplying the heart.According to Dr Arpan Desai, lead interventional cardiologist at Aadicura Superspeciality Hospital, the patient’s pre-existing renal dysfunction made coronary artery bypass grafting (CABG) a limited option because the bypass procedure can involve reduced blood pressure and cardiac output, potentially increasing the risk of acute kidney injury.After discussing the treatment options with the relatives, the team opted for rotablation-assisted percutaneous coronary intervention (PCI).Rotablation involves a specialised high-speed rotating burr, operating at about 1.4 lakh revolutions per minute, to modify and fracture hard calcium deposits inside a coronary artery.This enables preparation of a heavily calcified artery for balloon expansion and stent placement. The procedure is particularly relevant in patients with extensive arterial calcification, where conventional balloon angioplasty may be difficult.In this case, around 16 rotablation runs were performed without procedural complications. A cutting balloon was subsequently used for further modification of the lesion, followed by placement of a drug-eluting stent, restoring blood flow satisfactorily.Given the patient’s kidney dysfunction, the team also took measures to minimise contrast exposure, using a very low volume of visipaque (iodixanol). The procedure was performed under local anaesthesia through a single arterial access, avoiding a surgical incision or suturing at the access site.The procedure was performed by interventional cardiologists Dr Nirav Panchani and Dr Darshan Mevada along with Dr Desai. The hospital said the case demonstrates the role of advanced interventional techniques in managing complex, heavily calcified coronary blockages in appropriately selected high-risk patients, including those with renal dysfunction.
