Multivessel pci with bifurcation

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69F with h/o VT arrest s/p AICD placement 2 years prior, provoked dvt/PE s/p IVC filter presents with 10 day history of lethargy and AMS. Different approach on this case personally. Thanks AngioDynamics, Inc. #alphavac

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Left main, tight ostial lcx, not a cabg candidate. Orbital atherectomy circ then left main and lad. 3.5x28 sky point circ crushed with 4.0x33 sky point, pot 5.0

5 years out and RCAs still surprise me from time to time. CA2+ was unimpressive until ivus showed 360degree rock. Orbital then 3.5 frontier

Last remaining vessel RCA, IFR positive. CTO LAD/LCX. Prior attempts at mcs through tortuous iliacs and grafts were unsuccessful. Left subclavian with profound tortuousity and ICD over axillary access site. PCI RCA was performed with right axillary access for impella cp mcs.

65M ESRD, HFrEF with EF 15-20% presented to outside facility for Nstemi an aoc CHF. Diffusely diseased vessels, not a CABG candidate. Impella mcs, orbital, prox to mid lad first for outflow, then TAP ostial circ and left main into LAD.