Extensive Calcification with Complete Visualization of Coronaries on Fluoroscopy without Contrast – An Interesting Case Overview

Extensive Calcification with Complete Visualization of Coronaries on Fluoroscopy without Contrast -An Interesting Case OverviewInvestigations: Hb 11.4 g/dl, total count 8,600 cells/mm3, Platelet count 2.36 lakh/mm3, Creatinine 1.4mg/dl, eGFR -45ml/ min/1.73m2,viral markers were negative, TSH 6.2mU/ml, Serum Calcium 9.8mg/dl, phosphate 6.9mg/dl, Liver function tests were normal, Sodium 138mEq/L, Potassium 4.95mEq/L, RBS 208mg/ dl, Lipid profile: Total Cholesterol 89mg/dl, Triglycerides 177mg/ dl, HDL 23mg/dl, VLDL 35mg/dl, LDL 31mg/dl.Ultrasound abdomen showed bilateral grade III renal parenchymal changes.Chest rays was normal.ECG showed sinus rhythm with no specific ST-T changes.2D Echo showed no regional motion abnormalities.He had grade I diastolic dysfunction with good LV systolic function of EF 60%.Coronary Angiogram: Suggestive of LMCA + Triple vessel disease (Images 1,2,3) LMCA -Thick calcific vessel with 50% stenosis LAD -(Type 3) Thick calcific vessel, ostio-proximal 90% stenosis, proximal to mid long segment 70-80% stenosis.Diagonal-1 large vessel, ostial disease, proximal 50% stenosis, distal 80-90% stenosis LCX -(Non-Dominant) calcific vessel, proximal to mid two discrete lesions 80-90% stenosis.OM-1 large vessel, ostioproximal 80-90% stenosis, mid 50% stenosis; OM-3 moderate size, proximal to mid two lesions 70-80% stenosis.RCA -(Dominant) Thick calcific vessel, proximal mild disease, mid long segment 60% stenosis, distal 60-70% stenosis PDA/PLV diseased Management: Advised CABG/Medical management (SYNTAX score > 22)