CASE20210729_006

Primary Angioplasty of Left Main in ACS with Cardiogenic shock

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Presenter

Hariom Tyagi

Authors

1

Affiliation

, India1
High-Risk Intervention (diabetes, heart failure, renal failure, shock, etc) - High-Risk Intervention

Primary Angioplasty of Left Main in ACS with Cardiogenic shock

1

, India1

Clinical Information

Patient initials or Identifier Number

UKD

Relevant Clinical History and Physical Exam

Patient C/O Angina on Exertion, radiate to B/L arm, Dyspnea on Exertion, associated with generalized weakness since 8-10 days, symptoms increased 2-3 hours prior to admission. Diagnosis – T2DM/HTN/CAD/ACS/AOE-III/DOE-IIECG- Irregular sinus rhythm with ST depression in lateral leads. 2 Normal LV Systolic Function (LVEF = 60%). 

Relevant Test Results Prior to Catheterization

His angiogram revealed – Double Vessel Disease with Left Main , left main Ostial 99% lesion (short).LAD proximal to mid 80-90% lesion. RCA Co-dominant, proximal 60-70% disease. 

Relevant Catheterization Findings

 PTCA TO Left Main: A 0.014¡± SION BLUE wire was used to cross the Left Main lesion. Direct stenting was done with Drug Eluting Stent RESOLUTE ONYX 3.5 X 15 mm was deployed in Left Main @ 16 atmosphere. Post dilatation done with NC sapphire balloon 4.0X 9 mm @ 18 atmosphere. GP IIb IIIa inhibitor was used during the procedure. Excellent result with TIMI III flow.PTCA TO LAD: In same sitting Left Coronary Artery was e ngaged with JL 3.5, 7F guide catheter. A 0.014¡± SION BLUE wire was used.

Interventional Management

Procedural Step

PTCA TO Left Main: A 0.014¡± SION BLUE wire was used to cross the Left Main lesion. Direct stenting was done with Drug Eluting Stent RESOLUTE ONYX 3.5 X 15 mm was deployed in Left Main @ 16 atmosphere. Post dilatation done with NC sapphire balloon 4.0X 9 mm @ 18 atmosphere. GP IIb IIIa inhibitor was used during the procedure. Excellent result with TIMI III flow.PTCA TO LAD: In same sitting Left Coronary Artery was engaged with JL 3.5, 7F guide catheter. A 0.014¡± SION BLUE wire was used to cross the LAD lesion. Pre dilatation done with SC sapphire balloon 2.0 X10 mm @ 12 atmosphere. Drug Eluting Stent RESOLUTE ONYX 3.0X 34 mm was deployed in LAD @ 16 atmosphere. Post dilatation done with NC sapphire balloon 3.5X 10 mm @ 18 atmosphere. 
LEFT MAIN TO LAD (CTO) &.pptx

Case Summary

Percutaneous intervention with stent implantation for LMCA disease has become a standard procedure in contemporary practice with safety, expedited recovery, and durability. Precise selection of the strategy aided by intra coronary imaging, functional evaluation, and mechanical support when needed have improved the immediate and long-term results in this high risk intervention. It is however important to have a team approach and operator expertise before embarking on LMCA interventions.