Webinar 8 | Bifurcation Badness - Cases from South Asia-Case presentation, Dr. Ashok Seth

Video Transcription

Video Summary

Dr. Seth from New Delhi presented a complex case of a 65-year-old diabetic patient with severe triple vessel coronary artery disease, depressed left ventricular function, and recent pulmonary edema, initially turned down for surgery. The patient underwent high-risk, Impella-supported percutaneous coronary intervention (PCI) addressing diffuse calcific trifurcation disease. Key strategies included rotational atherectomy, intravascular lithotripsy (IVL), cutting balloons, and drug-coated balloons (DCB) to optimize vessel preparation and drug delivery without excessive stenting. Imaging played a critical role in guiding treatment, achieving excellent vessel expansion and ensuring safe, effective revascularization. The case highlighted the importance of mechanical circulatory support in hemodynamically vulnerable patients, meticulous lesion preparation, and the expanding role of DCB in diffuse small vessel disease common in South Asia. At six months, the patient was asymptomatic with improved ejection fraction, illustrating the potential of advanced PCI techniques combined with careful patient selection and comprehensive imaging in managing complex coronary artery disease.

Keywords

Impella-supported PCI

rotational atherectomy

intravascular lithotripsy

drug-coated balloons

mechanical circulatory support

diffuse small vessel disease