E-Science Station

CASE20210816_004

Primary PCI in Patients with Diffuse Triple Vessel Disease

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Presenter

Rohit Mody

Authors

1

Affiliation

, India1
Complex PCI - Multi-Vessel Disease

Primary PCI in Patients with Diffuse Triple Vessel Disease

1

, India1

Clinical Information

Patient initials or Identifier Number

case1- 75122 case2- 201201 Case3- 201447

Relevant Clinical History and Physical Exam

Case1- 48 Year old Male History of Chest Pain in ER Ischemia Time- 10hrs Window period- 60mins  Case2- 64 year old Male Presented with Chest pain since 48 hours Case3- 76 Year old male CAD recent s/p PCI to LAD Presented in ER with ACS ( STEMI)

Relevant Test Results Prior to Catheterization

Case 1- ECG showed- Anterior STEMICase 2- ECG shows Acute ST elevation Anterior MI ECHO shows RWMA in LAD territory EF 28% Ischemia Time more than 48hrs. Window period 60 mins. Case 3- ACS ( STEMI)

Relevant Catheterization Findings

Case1- TVD with LAD 100% at the ostium 
Case2- LAD proximal LAD 100% occluded 
Case3- LAD 100% and diffused disease along mid to distal LAD



Interventional Management

Procedural Step

Case1- BMW Wire failed to cross even with balloon support, Crossed with XTA wire which didn’t reached Apex probably diffuse disease distally or Sub-intimal, Pre Dilation with 2.0mm Balloon, 2.75x15mm Stent deployed at Ostium LAD, Distal LAD seen as a Diffused disease Distally also PDA & PLV diffused disease filling Retrogradely, 2.5x38mm Stent deployed Mid to Distal RCA, 3.0x28mm Stent deployed in Proximal to mid RCA, 

Case2- Lesion crossed with BMW wire with balloon Support, Pre Dilation with 1.5x12mm Balloon, Lesion crossed with BMW wire , Pre Dilated with 2.5mm balloon, Diffuse Disease in distal LAD. 

Case 3- Angiography done previously showed tight lesion in LAD which is Type 2 (elsewhere), Crossed with Floppy wire, Predilatation done (Elsewhere), PCI to LAD done and DES deployed (Elsewhere), D1 shows mild disease & flowing & Post PCI Stent occluded on table LAD shows 100% occlusion, LAD to D1 crossed with wire, Balloon dilated with 2.5x15mm balloon, Stent 2.5x23mm in LAD to D1, Good flow, LAD could not be crossed and moreover, ST elevation settled and pain relived,

Case Summary

When there is diffuse disease distally only the proximal stenting may suffice with good resolution of ST elevation and relief of pain in patients with acute MI, multivessel and Diffuse Disease. knowing when to quit, why sometimes you have to stop & say "That's all i can do".