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TCTAP C-146 Bleeding Complications After Resolve Acute Stent Thrombosis
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S269
TCTAP C-146 Bleeding Complications After Resolve Acute Stent Thrombosis Hotmauli Siahaan,1 Yudi Her Oktaviono2 Adi Husada Hospital Surabaya, Indonesia; 2Dr. Soetomo Hospital, Surabaya, Indonesia 1
[CLINICAL INFORMATION] Patient initials or identifier number. Mr. X Relevant clinical history and physical exam. Mr. X, 55 years old with history of diabetes and hypertension admitted to hospital with severe chest pain. The ECG showed an anterolateral ischemia. Angiography revealed a significant stenosis at proximal LAD and distal LCX (figure 1)
[INTERVENTIONAL MANAGEMENT] Procedural step. We decide to open the proximal LAD and insert a stent (figure 2) and continue to advance the wire to the distal LCX. But during the film making, we found haziness at the osteal LCX. We tried to remove by ballooning from proximal to osteal LCX, unfortunately we found thrombus at proximal LAD (figure 3). The patient then presented with severe chest pain and hypotension. We tried to administrate integrilin intracoronary followed by maintenance intravenous, but the thrombus didn’t resolve. So we decided to administrate streptokinase intracoronary followed by inserting balloon and another stent at the osteal to proximal LAD. Finally the results was good, with TIMI 3 flow (figure 4).
Case Summary. After an extended duration procedure, we managed to successfully wire into the true LAD lumen. We proceeded to deploy 2 overlapping stents - 2.5 x 20 mm and 2.5 x 32 mm Synergy DES into the mid LAD. Post dilatation was performed with a 3 x 12 mm non-compliant balloon. There was a small residual dissection in the distal LAD but decision was made not for further stenting. A repeat coronary angiogram was performed after 2 months which showed the dissection healed well and the diagonal branches recanalised. The patient remained well with a systolic function of 40%. Lessons learnt: 1. Be aware of unusual anatomic vascular variations. 2. Do not aggressively predilate if unsure of distal vasculature.
S270
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Case Summary. The patientclinically improved with decrease of chest pain and stable haemodynamics. Thepatient was transferred to ICCU. Later, we found a big hematom from lowerabdominal to extremities. The laboratory analysis found decrease of haemoglobinfrom 13 gr % to 7 gr %. the patient complained of dizziness and drop of bloodpressure. WBC transfusion was given until Hb increased to normal whilediscontinuing anti platelet until five days. The patient was discharge andplanned for further elective PCI on the distal LCX. TCTAP C-147 Complicated Perforation After Stent Implantation in Chronic Total Occlusion in Left Anterior Decending Artery Manotosh Panja1 1 BelleVue Clinic, India [CLINICAL INFORMATION] Patient initials or identifier number. 65 years male Relevant clinical history and physical exam. 65 years male presented with ACS on a background of stable angina for last 2 years. Non DM, non-smoker, HTN, dyslipidemia CAG showed proximal LAD 99% lesion and mid LAD CTO after D1 which is only detectable by retrograde the collateral (SA nodal artery from proximal RCA). [INTERVENTIONAL MANAGEMENT] Procedural step. Used micro catheter and filder XT wire to cross theCTO. After repeated dilatation Resolute 2.5x30 deployed at the distal lesion.Another resolute 2.5x30 were deployed with some overlapping with proximal endof the distal stent. During the post dilatation the junction of the both stents got deformed which caused huge perforation with cardiac tamponed and collapsed. The patient was immediately ventilated. Drainage of pericardial effusion andauto transfusion done. Balloon inflation was done for 30 minutes in low pressure as the cover stentdid not reach the site of perforation and referred for surgical intervention which failed to stop the wosing of the blood from the perforation. Ultimately the patient died after 48 hours.
S269
TCTAP C-146 Bleeding Complications After Resolve Acute Stent Thrombosis Hotmauli Siahaan,1 Yudi Her Oktaviono2 Adi Husada Hospital Surabaya, Indonesia; 2Dr. Soetomo Hospital, Surabaya, Indonesia 1
[CLINICAL INFORMATION] Patient initials or identifier number. Mr. X Relevant clinical history and physical exam. Mr. X, 55 years old with history of diabetes and hypertension admitted to hospital with severe chest pain. The ECG showed an anterolateral ischemia. Angiography revealed a significant stenosis at proximal LAD and distal LCX (figure 1)
[INTERVENTIONAL MANAGEMENT] Procedural step. We decide to open the proximal LAD and insert a stent (figure 2) and continue to advance the wire to the distal LCX. But during the film making, we found haziness at the osteal LCX. We tried to remove by ballooning from proximal to osteal LCX, unfortunately we found thrombus at proximal LAD (figure 3). The patient then presented with severe chest pain and hypotension. We tried to administrate integrilin intracoronary followed by maintenance intravenous, but the thrombus didn’t resolve. So we decided to administrate streptokinase intracoronary followed by inserting balloon and another stent at the osteal to proximal LAD. Finally the results was good, with TIMI 3 flow (figure 4).
Case Summary. After an extended duration procedure, we managed to successfully wire into the true LAD lumen. We proceeded to deploy 2 overlapping stents - 2.5 x 20 mm and 2.5 x 32 mm Synergy DES into the mid LAD. Post dilatation was performed with a 3 x 12 mm non-compliant balloon. There was a small residual dissection in the distal LAD but decision was made not for further stenting. A repeat coronary angiogram was performed after 2 months which showed the dissection healed well and the diagonal branches recanalised. The patient remained well with a systolic function of 40%. Lessons learnt: 1. Be aware of unusual anatomic vascular variations. 2. Do not aggressively predilate if unsure of distal vasculature.
S270
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Case Summary. The patientclinically improved with decrease of chest pain and stable haemodynamics. Thepatient was transferred to ICCU. Later, we found a big hematom from lowerabdominal to extremities. The laboratory analysis found decrease of haemoglobinfrom 13 gr % to 7 gr %. the patient complained of dizziness and drop of bloodpressure. WBC transfusion was given until Hb increased to normal whilediscontinuing anti platelet until five days. The patient was discharge andplanned for further elective PCI on the distal LCX. TCTAP C-147 Complicated Perforation After Stent Implantation in Chronic Total Occlusion in Left Anterior Decending Artery Manotosh Panja1 1 BelleVue Clinic, India [CLINICAL INFORMATION] Patient initials or identifier number. 65 years male Relevant clinical history and physical exam. 65 years male presented with ACS on a background of stable angina for last 2 years. Non DM, non-smoker, HTN, dyslipidemia CAG showed proximal LAD 99% lesion and mid LAD CTO after D1 which is only detectable by retrograde the collateral (SA nodal artery from proximal RCA). [INTERVENTIONAL MANAGEMENT] Procedural step. Used micro catheter and filder XT wire to cross theCTO. After repeated dilatation Resolute 2.5x30 deployed at the distal lesion.Another resolute 2.5x30 were deployed with some overlapping with proximal endof the distal stent. During the post dilatation the junction of the both stents got deformed which caused huge perforation with cardiac tamponed and collapsed. The patient was immediately ventilated. Drainage of pericardial effusion andauto transfusion done. Balloon inflation was done for 30 minutes in low pressure as the cover stentdid not reach the site of perforation and referred for surgical intervention which failed to stop the wosing of the blood from the perforation. Ultimately the patient died after 48 hours.