Right Coronary Artery Calcified Nodule Pre-TAVI Treatment Facilitated by ELCA Atherectomy

Background: Managing calcified nodules remains a clinical challenge. Case Summary: A 77-year-old man underwent coronary angiography during pre-transcatheter aortic valve implantation workout, showing a severe middle right coronary artery stenosis associated with a suspicious angiographic calcified nodule. Excimer laser was used for plaque preparation and for facilitating subsequent optical coherence tomography intracoronary imaging–guided percutaneous coronary intervention (PCI). Excimer laser coronary angioplasty was successfully performed, with a good final PCI result. Discussion: This case illustrates the practical application of a niche device (eg, excimer laser coronary angioplasty) as a useful tool to tackle calcified nodules and to allow a state-of-the-art PCI.