Euro4C Cases - the management of complex patients with calcified CAD

Analyze this case to find out how to successfully manage a patient with severe aortic stenosis and severely calcified peripheral vasculature referred to transcatheter aortic valve implantation.

Managing calcified lesions is always a challenge, and while rotablation is the default technique, other methods must sometimes be considered, especially for eruptive calcified nodules, such as Shockwave, OPN balloon, or orbital atherectomy.

This case illustrates the challenges of managing a previously bypassed patient in an acute setting with LM disease and high calcium burden involving LAD and Cx ostias, and occlusion of the venous graft towards the Cx. The tortuous anatomy is a further hurdle to management and choice...

How should this 74-year-old woman with HTN, DM, LVEF 45 %, inferior hypokinesia, and no valvular disorders be managed after presenting with a subacute inferior STEMI of less than 24 hours? Before uncovering the authors' approach, provide your analysis!

How would you treat this 83-year-old male patient with LM, MVD, RCA CTO, severely reduced EF, and constrictive surgical valve?

How would you treat this 81-year-old male patient with HTN, diabetes, dyslipidemia, peripheral vasculopathy, previous coronary angioplasty and prostatic adenocarcinoma, who was admitted for effort angina and positive stress test?

How would you treat an extremely calcified sub-occluded LM in a 72-year-old man presenting on "dependent stability and sliding on inotropes"(*), refused by surgery?

(*) INTERMACS III to II

How would you treat a 90-year-old female patient with HTN, dyslipidaemia, paroxysmal AF, CCS and CKD, whose stable angina CCS II has been worsening for a few months and whose angio reveals severe calcified stenosis of the proximal and middle LAD? 

How would you treat this 76-year-old male patient with severe AS symptomatic for angina, sinus rhythm with RBBB, previous bilateral CEA, and total occlusion of both the left CCA and the subclavian?

Find out more about how the authors managed a 53-year old male with ischemic cardiomyopathy, EF 25 %, and calcified 3-vessel disease !