The First Orbital Atherectomy in a Heavily Calcified Angulated Mid Left Anterior Descending Segment in Bangkok Dusit Medical Services.

We report the first case of Orbital Atherectomy with heavily calcified, angulated segment of mid left anterior descending artery (LAD) at the Bangkok Heart Hospital, using a new innovation to prepare the lesion, as this condition is difficult to treat with conventional percutaneous coronary intervention such as coronary balloons and coronary stents. Currently, there are multiple modalities of treatment such as cutting balloon angioplasty, rotational atherectomy, intravascular lithotripsy or orbital atherectomy. We describe the step by step management of this heavily calcified lesion with the use of an infrared optical coherence tomography to identify calcium thickness, calcium length and calcium arc before introducing the new innovation strategy, using Diamondback 360 for orbital sanding on the circumferential vessel wall, both retrograde and antegrade, at both low and high speed, before larger balloon angioplasty and stent implantation with the proper stent sizing and stent length.