PCI to midLAD bifurcation lesion with anterior STEMI complicated by ac

Information about PCI to midLAD bifurcation lesion with anterior STEMI complicated by ac

Published on August 9, 2014

Author: leongwsan5

Source: authorstream.com

Content

PCI for Anterior STEMI with mid LAD bifurcation lesion, complicated by periprocedural acute LAD closure and bifurcation stenting: PCI for Anterior STEMI with mid LAD bifurcation lesion, complicated by periprocedural acute LAD closure and bifurcation stenting Dr Leong Weng San, MD( UKM), MRCP(UK), MMED (NUS); Invasive Cardiology Laboratory, Hospital Raja Permaisuri Bainun Ipoh, Malaysia PCI for Anterior STEMI with mid LAD bifurcation lesion, complicated by periprocedural acute LAD closure and bifurcation stenting Case Title : PCI for Anterior STEMI with mid LAD bifurcation lesion, complicated by periprocedural acute LAD closure and bifurcation stenting Case Title 45 year old Chinese gentleman presented to district hospital with acute anterior STEMI on 20 May 2014 referred to us for rescue PCI after failed thrombolysis On arrival: On arrival ECG –resolution of ST segment Patient has persistent angina Proceed with coronary angiogram PowerPoint Presentation: coronary angiogram via right radial approach showed single vessel disease Mid LAD was 95% bifurcation lesion, madina class 1,1,1 (Figure 1). He has TIMI 2-3 flow in LAD. Figure 1: MidLAD 95% stenosis Madina 1,1,1 : Figure 1: MidLAD 95% stenosis Madina 1,1,1 PCI: PCI . Left coronary system was engaged with 6Fr EBU 3.5 guiding catheter. IC heparin 7000 unit given. Initial strategy was provisional midLAD stenting . PCI to midLAD: PCI to midLAD Could not cross the midLAD lesion: Could not cross the midLAD lesion Finecross used but failed wiring of LAD main vessel with soft wire: Finecross used but failed wiring of LAD main vessel with soft wire Filter XT via Crusade: Filter XT via Crusade Allset for subsequent PCI but: Allset for subsequent PCI but Accidental wire full back and failed rewire with soft wire, Fielder XT: Accidental wire full back and failed rewire with soft wire, Fielder XT More ischemic and wire in dissection plane : More ischemic and wire in dissection plane Persistent angina and restless. What to do?: Persistent angina and restless. What to do? Problem now: Problem now 1) Restless patient 2) More ischemic LAD/ D1 3) Few dissection flaps created along the struggle 4) Ostial D1 risk of closing off Solutions: Solutions 1) Reduce ischemia to some extent 2) use different wire with better trackability 3) Avoid enter into dissection again What was happening: What was happening Dissection True lumen track Potential Gain in stenting the Diagonal: Potential Gain in stenting the Diagonal Stent struts closed off dissection flap and false lumen entry Decided to poba D1, followed by stenting: Decided to poba D1, followed by stenting Post Poba: Post Poba Stented Diagonal with DES: Stented Diagonal with DES Positioning of the Crusade is crucial: Positioning of the Crusade is crucial I chose the right wire: I chose the right wire PowerPoint Presentation: Fielder XTA able to enter into true lumen of LAD. LAD was predilated with Minitrek 2.0 x15mm, followed by LAD stenting with Promus Premier 2.75 x38mm Main vessel Cullotte stening: Main vessel Cullotte stening PowerPoint Presentation: Final kissing balloon was performed with Sapphire NC 2.75 x15 (LAD) and NC Trek 2.5 x15mm (diagonal).Final results was good with good TIMI 3 flow. Final results: Final results Final results –good branch preservation: Final results –good branch preservation Why this case interesting: Why this case interesting 1) Accidental wire displacement- results in closure happen despite attention paid to avoid this 2) AMI keep it simple, but bifurcation stenting need to be done to reduce ischemia earlier 3) Make use of Crusade to wire into angulated main branch and correct wire used may improve procedural success 4) It will happen again Thank you: Thank you

Related presentations


Other presentations created by leongwsan5