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TCTAP C-008 A Successful PCI Case for STEMI Treated by ELCA and PCB Without Stent
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
S97
1. First, Apex OTW balloon catheter 1.5 x 20 mm with Run through NS ultra-floopy could successfully pass to LCX#15 and dilated the occluded lesion up to 14 atm 2. Good dilatation and TIMI 3 flow were obtained 3. IVUS revealed the vessel diameter was small (ref. 2.0 mm) and diffuse thrombus with a fibrous plaque. Thus we chose ELCA without stent strategy 4. Excimer Laser (VitesseCos, 1.4 mm) could successfully ablate the thrombus and plaque. 5. Long dilatation of Tazuna PTCA balloon Catheter 2.0 x 15 mm was performed to occluded lesion at the LCX#15 6. Paclitaxiel coated balloon 2.0 x 20 mm was used to the lesion 7. We confirmed good dilation by the IVUS and angiography 8. She could uneventfully discharge at 14th hospital day
Case Summary. Establishing flow in an occluded artery is the urgent requirement in a primary PCI situation. The present case highlights an effective, simple, low-cost innovative technique of creating a “perfusion” balloon in the cath lab and successfully delivering intracoronary vasodilator distal to a tight occlusion in the LAD vessel. The innovation helped in bailing-out the patient and allowed for completion of subsequent stenting and salvage of the patient after routine measures had failed. The author through this innovative technique highlights the challenges of a primary PCI procedure and the constant need to think out-of-the-box to save the occasionally complicated patient.
TCTAP C-008 A Successful PCI Case for STEMI Treated by ELCA and PCB Without Stent Satoshi Tobita1 Kochi Health Sciences Center, Japan
1
[CLINICAL INFORMATION] Patient initials or identifier number. K.K Relevant clinical history and physical exam. A case was 61 year-old female. Her past history was hypertension. She felt a chest pain from yesterday, so consulted a home doctor. She was suspected acute coronary syndrome and transferred to our hospital. In our hospital, her hemodynamics and respiratory condition were stable. There was not the abnormality of the physical exam, but chest pain lasted. Relevant test results prior to catheterization. ECG showed ST elevated in leads II, III, aVF and V5-6. There was not the abnormality by chest X-rays. Cardiac echo showed myocardial infarction on the inferior wall, and then emergent coronary angiogram was performed. Relevant catheterization findings. Emergent CAG revealed total occlusion at left circumflex posterior descending artery (LCX#15) and collateral vessels from the left anterior descending artery to LCX#15. Emergent PCI was performed to LCX#15. [INTERVENTIONAL MANAGEMENT] Procedural step. Procedural step. 7Fr sheath from the right radial artery. Guiding catheter: Heartrail II IL3.5 7F. Guidewire: Run through NS ultra floppy. Balloon: Apex OTW PTCA Balloon Dilation Catheter 1.5 x 20 mm, Tazuna PTCA Balloon Catheter 2.5 x 20 mm, SeQuent Please Drug Eluting Balloon Catheter 2.5 x 20 mm
S98
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
Case Summary. We experienced a case of STEMI treated by ELCA and PCB without a stent. 3 m-f/u CAG showed no restenosis and good TIMI flow in LCX. ELCA with PCB would be a good choice for the lesion in the small vessel unsuited for stent implantation even in the ACS setting. TCTAP C-009 Thrombotic Occlusion of Left Main Coronary Artery in Young Patient Tamiruddin A. Danwade,1 Rajeev V. Menon,1 Swaroop Govind Bharadi1 1 Care Hospital Hi Tech City, India [CLINICAL INFORMATION] Patient initials or identifier number. Mr. NKR Relevant clinical history and physical exam. A 34 years old gentleman, driver by occupation unknown case of diabetes mellitus or hypertension nonsmoker but occasional alcoholic, presented to the emergency (ER)of our hospital with severe ongoing chest pain from 4 hours. Prior to this, he went to another hospital where he was diagnosed with an acute myocardial infarction and was referred to the higher center. He was very agitated literally tossing in the bed when presented. Clinical examination: P- 84 /min. Bp- 130/80 mm of Hg RR- 16 per minute Systemic examination was normal. Relevant test results prior to catheterization. ECG was done immediately which was suggestive of acute anterior wall myocardial infarction. An echocardiogram was s/o LAD territory akinesia with moderate LV systolic dysfunction and LVEF of 40% Blood urea 17 mg/dl Serum creatinine 0.89 mg/dl Hemoglobin 17.8 gm/dl HIV, HBsAg, HCV were negative
S97
1. First, Apex OTW balloon catheter 1.5 x 20 mm with Run through NS ultra-floopy could successfully pass to LCX#15 and dilated the occluded lesion up to 14 atm 2. Good dilatation and TIMI 3 flow were obtained 3. IVUS revealed the vessel diameter was small (ref. 2.0 mm) and diffuse thrombus with a fibrous plaque. Thus we chose ELCA without stent strategy 4. Excimer Laser (VitesseCos, 1.4 mm) could successfully ablate the thrombus and plaque. 5. Long dilatation of Tazuna PTCA balloon Catheter 2.0 x 15 mm was performed to occluded lesion at the LCX#15 6. Paclitaxiel coated balloon 2.0 x 20 mm was used to the lesion 7. We confirmed good dilation by the IVUS and angiography 8. She could uneventfully discharge at 14th hospital day
Case Summary. Establishing flow in an occluded artery is the urgent requirement in a primary PCI situation. The present case highlights an effective, simple, low-cost innovative technique of creating a “perfusion” balloon in the cath lab and successfully delivering intracoronary vasodilator distal to a tight occlusion in the LAD vessel. The innovation helped in bailing-out the patient and allowed for completion of subsequent stenting and salvage of the patient after routine measures had failed. The author through this innovative technique highlights the challenges of a primary PCI procedure and the constant need to think out-of-the-box to save the occasionally complicated patient.
TCTAP C-008 A Successful PCI Case for STEMI Treated by ELCA and PCB Without Stent Satoshi Tobita1 Kochi Health Sciences Center, Japan
1
[CLINICAL INFORMATION] Patient initials or identifier number. K.K Relevant clinical history and physical exam. A case was 61 year-old female. Her past history was hypertension. She felt a chest pain from yesterday, so consulted a home doctor. She was suspected acute coronary syndrome and transferred to our hospital. In our hospital, her hemodynamics and respiratory condition were stable. There was not the abnormality of the physical exam, but chest pain lasted. Relevant test results prior to catheterization. ECG showed ST elevated in leads II, III, aVF and V5-6. There was not the abnormality by chest X-rays. Cardiac echo showed myocardial infarction on the inferior wall, and then emergent coronary angiogram was performed. Relevant catheterization findings. Emergent CAG revealed total occlusion at left circumflex posterior descending artery (LCX#15) and collateral vessels from the left anterior descending artery to LCX#15. Emergent PCI was performed to LCX#15. [INTERVENTIONAL MANAGEMENT] Procedural step. Procedural step. 7Fr sheath from the right radial artery. Guiding catheter: Heartrail II IL3.5 7F. Guidewire: Run through NS ultra floppy. Balloon: Apex OTW PTCA Balloon Dilation Catheter 1.5 x 20 mm, Tazuna PTCA Balloon Catheter 2.5 x 20 mm, SeQuent Please Drug Eluting Balloon Catheter 2.5 x 20 mm
S98
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
Case Summary. We experienced a case of STEMI treated by ELCA and PCB without a stent. 3 m-f/u CAG showed no restenosis and good TIMI flow in LCX. ELCA with PCB would be a good choice for the lesion in the small vessel unsuited for stent implantation even in the ACS setting. TCTAP C-009 Thrombotic Occlusion of Left Main Coronary Artery in Young Patient Tamiruddin A. Danwade,1 Rajeev V. Menon,1 Swaroop Govind Bharadi1 1 Care Hospital Hi Tech City, India [CLINICAL INFORMATION] Patient initials or identifier number. Mr. NKR Relevant clinical history and physical exam. A 34 years old gentleman, driver by occupation unknown case of diabetes mellitus or hypertension nonsmoker but occasional alcoholic, presented to the emergency (ER)of our hospital with severe ongoing chest pain from 4 hours. Prior to this, he went to another hospital where he was diagnosed with an acute myocardial infarction and was referred to the higher center. He was very agitated literally tossing in the bed when presented. Clinical examination: P- 84 /min. Bp- 130/80 mm of Hg RR- 16 per minute Systemic examination was normal. Relevant test results prior to catheterization. ECG was done immediately which was suggestive of acute anterior wall myocardial infarction. An echocardiogram was s/o LAD territory akinesia with moderate LV systolic dysfunction and LVEF of 40% Blood urea 17 mg/dl Serum creatinine 0.89 mg/dl Hemoglobin 17.8 gm/dl HIV, HBsAg, HCV were negative