CASE20210729_006
Primary Angioplasty of Left Main in ACS with Cardiogenic shock
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0
Presenter
Hariom Tyagi
Authors
1
Affiliation
, India1
High-Risk Intervention (diabetes, heart failure, renal failure, shock, etc) - High-Risk Intervention
Primary Angioplasty of Left Main in ACS with Cardiogenic shock
1
, India1
Clinical Information
Patient initials or Identifier Number
UKD
Relevant Clinical History and Physical Exam
Patient C/O Angina on Exertion, radiate to B/L arm, Dyspnea on Exertion, associated with generalized weakness since 8-10 days, symptoms increased 2-3 hours prior to admission. Diagnosis – T2DM/HTN/CAD/ACS/AOE-III/DOE-IIECG- Irregular sinus rhythm with ST depression in lateral leads. 2 Normal LV Systolic Function (LVEF = 60%).
Relevant Test Results Prior to Catheterization
His angiogram revealed – Double Vessel Disease with Left Main , left main Ostial 99% lesion (short).LAD proximal to mid 80-90% lesion. RCA Co-dominant, proximal 60-70% disease.
Relevant Catheterization Findings
PTCA TO Left Main: A 0.014” SION BLUE wire was used to cross the Left Main lesion. Direct stenting was done with Drug Eluting Stent RESOLUTE ONYX 3.5 X 15 mm was deployed in Left Main @ 16 atmosphere. Post dilatation done with NC sapphire balloon 4.0X 9 mm @ 18 atmosphere. GP IIb IIIa inhibitor was used during the procedure. Excellent result with TIMI III flow.PTCA TO LAD: In same sitting Left Coronary Artery was e ngaged with JL 3.5, 7F guide catheter. A 0.014” SION BLUE wire was used.
Interventional Management
Procedural Step
PTCA TO Left Main: A 0.014” SION BLUE wire was used to cross the Left Main lesion. Direct stenting was done with Drug Eluting Stent RESOLUTE ONYX 3.5 X 15 mm was deployed in Left Main @ 16 atmosphere. Post dilatation done with NC sapphire balloon 4.0X 9 mm @ 18 atmosphere. GP IIb IIIa inhibitor was used during the procedure. Excellent result with TIMI III flow.PTCA TO LAD: In same sitting Left Coronary Artery was engaged with JL 3.5, 7F guide catheter. A 0.014” SION BLUE wire was used to cross the LAD lesion. Pre dilatation done with SC sapphire balloon 2.0 X10 mm @ 12 atmosphere. Drug Eluting Stent RESOLUTE ONYX 3.0X 34 mm was deployed in LAD @ 16 atmosphere. Post dilatation done with NC sapphire balloon 3.5X 10 mm @ 18 atmosphere.
LEFT MAIN TO LAD (CTO) &.pptx
LEFT MAIN TO LAD (CTO) &.pptxCase 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.