CASE20210729_004

Primary Angioplasty of Left Main in ACS

By Hariom Tyagi
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Presenter

Hariom Tyagi

Authors

Hariom Tyagi1

Affiliation

Lokpriya Hospital, India1
High-Risk Intervention (diabetes, heart failure, renal failure, shock, etc) - High-Risk Intervention

Primary Angioplasty of Left Main in ACS

Hariom Tyagi1

Lokpriya Hospital, India1

Clinical Information

Patient initials or Identifier Number

DK

Relevant Clinical History and Physical Exam

C/O Chest Pain, Sweating, associated with generalized weakness for last 1 day prior to admission.Diagnosis – CAD/ACS/ACUTE AWMI (LP)/SEVERE LV SYSTOLIC DYSFUNCTION/ LVEF=15%/MODERATE MR/MILD TR/MILD PAH/ECG- Acute Anterior Wall MI. 

Relevant Test Results Prior to Catheterization

Left Main: Ostial 95% disease.LAD: Proximal 90% disease flowed by 99% disease.D1& D2: Normal.LCX: Non-Dominant, Normal.OM1 & OM2: Normal.RCA: Dominant, Proximal 50-60% disease, Mid 60-70% Tandem lesion.PLV/PDA: Normal. 

Relevant Catheterization Findings

Left Main: Ostial 95% disease.LAD: Proximal 90% disease flowed by 99% disease.D1& D2: Normal.LCX: Non-Dominant, Normal.OM1 & OM2: Normal.RCA: Dominant, Proximal 50-60% disease, Mid 60-70% Tandem lesion. PLV/PDA: Normal.  

Interventional Management

Procedural Step

Left Coronary Artery was engaged with JL 3.5, 7F guide catheter. A 0.014” SION BLUE wire was used to cross the Left Main to LAD lesion. Pre dilation done with SC Sapphire Balloon 2.75 X10 mm @ 10 atmosphere. Drug Eluting Stent XIENCE XPEDITION LL 3.5 X 38 mm deployed in Left Main to Proximal LAD @ 10 atmosphere. Post dilation done with NC Sapphire Balloon 4.5 X 8 mm @ 10 atmosphere. GP IIb IIIa inhibitor was used during the procedure. Excellent result with TIMI III flow. Successful PTCA with stenting to Left Main to LAD. 

Case Summary

Percutaneous intervention with stent implantation for LMCA disease has become a standard procedure in contemporary practice with safety, expedited recovery, and durability. Precise selection of the strategy aided by intra coronary imaging, functional evaluation, and mechanical support when needed have improved the immediate and long-term results in this high risk intervention. It is however important to have a team approach and operator expertise before embarking on LMCA interventions