33846450

This 82 years old man with history of hypertension, hospitalized this time for right hepatic tumor resection. However acute respiratory failure found after operation. ECG found diffused ST segment depression with AVR ST elevation. Thus coronary angiography suggested and arranged.

Acute respiratory failure after operation underwent endotracheal tube intubation. ECG found diffused ST segment depression with AVR ST elevation.

LM 85% stenosisLAD-P 99% stenosisLAD-M 90% stenosisLCX-P 95% stenosisLCX-D 90% stenosisLCX-PL 85% stenosisRCA-P CTO
001(1).avi
001(3).avi
001(4).avi
20201216(1).avi

Under PCPS support via right femoral artery and vein, we punctured via left femoral artery under echo-guiding puncture was done. POBA for LM-LAD-P and LCX-P bifurcation was gradually done angioplasty with 2.5mm diameter balloon kissing. And then we used 3.0 diameter balloon with kissing technique. Then we do double kissing crush stenting to LM bifurcation (LM-LAD-P ONYX 3.0 x 22 mm, LM-LCX ONYX 3.0 x 34 mm). Stage PCI for RCA CTO consider with retrograde manner with septal approach will be performed later. Soonly, PCPS removed after the procedure. And he smoothly extubated afterwards.
20201216(24).avi
20201216(25).avi

This case presented high risk triple vessel and LM bifurcation and RCA CTO CAD patient with AMI underwent successful PCI under PCPS support. And the most important evaluation before PCI is critical step. After discussed with heart team, PCPS supported PCI suggested. And the final result showed good. And it really lowering the risk of cardiac arrest during high risk CHIP PCI.