Precision Intervention for Complex Calcified Lesions: Technical SOP Analysis from Fuwai Hospital Beijing

🔷 [1. Clinical Profile & Risk Stratification]
● Patient Profile: 75-year-old with multi-vessel CAD; compensated cardiac function.
● Anatomical Challenges: Diffuse coronary calcification with 360° circumferential rings; stenosis >95%.
● Surgical Risk: Ineligible for CABG due to advanced age; history of two failed PCI attempts elsewhere.
● Core Objective: Achieving plaque modification and revascularization via High-Speed Rotational Atherectomy (RA).

🔬 [2. Evidence-Based Decision Logic]
● Hybrid Strategy: Combination of Retrograde Wire Technique and Rotational Atherectomy.
● Imaging Gold Standard: Utilizing Intravascular Ultrasound (IVUS) as the "Third Eye" to guide the entire procedure.
● Burr Selection: 1.25mm burr matched precisely to a 0.5-0.6 burr-to-artery ratio based on pre-op IVUS measurements.

⚡ [3. Structured Procedure & Technical Parameters]
🕒 11:00 AM | Pre-ablation Assessment: IVUS scanning to quantify calcium thickness (>0.5mm) and distribution.
🕒 11:30 AM | Rotational Atherectomy: ▪️ Speed Control: Maintained constant at 160,000 - 180,000 RPM. ▪️ Operating Technique: "Pecking" motion with short bursts (3-4 seconds per run). ▪️ Safety Protocol: Continuous monitoring to prevent thermal injury and "Slow Flow" phenomenon.
🕒 12:15 PM | Lesion Modification: IVUS-confirmed fracture of the calcified ring, followed by successful retrograde wire passage.
🕒 01:00 PM | Precision Stenting: Stent sizing guided by reference diameter; post-dilatation verification of >80% expansion and zero edge dissection.

✅ [4. Institutional Excellence & Outcomes]
▪️ Procedural Success: 120-minute total time; TIMI 3 flow achieved with <5% residual stenosis.
▪️ Institutional Strength: As a National Clinical Research Center, Fuwai Hospital performs the highest volume of Rotablation procedures in China annually.
▪️ Multidisciplinary Support: Supported by a dedicated IVUS technician team (12 certified specialists) to ensure imaging precision.