22 May 2026
Calcified lesion of distal protected left main - LIVE case
Summary
An 85‑year‑old man with type 2 diabetes mellitus, hypertension, dyslipidemia, peripheral artery disease, COPD, and chronic kidney disease presented with CCS class II angina related to three‑vessel coronary artery disease. He had previously undergone hybrid revascularization, including PCI of the RCA ostium and CABG with LIMA to LAD.
The calcified distal left main lesion was prepared using rotational atherectomy (1.75 mm burr) and intravascular lithotripsy (IVL, Shockwave C2). Provisional stenting from the left main to the circumflex artery (LM–CX) was then performed under IVUS guidance.
LIVE Educational Case from Leipzig Heart Centre - Leipzig, Germany
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Key moments
- 7:45-10:32 - Procedural analysis
- 19:10-22:16 - Rotablator
- 25:18-1:05:32 - IVUS
- 32:54-44:20 - IVL
Keywords: Left main bifurcation, calcified lesion, Rotablator, IVL C2 aero, IVUS, provisional stenting
Learning Objectives
- To understand key aspects of complexity of calcified coronary lesions
- To appreciate strategies for adequate calcified lesion preparation
- To discuss the supportive role of intravascular imaging
