RA

A 53 year old female a known case of Hypertension ,CAD-IWMI ,thrombolysed with tenectplase elsewhere followed by rescue PTCA Admittted for Staged PTCA TO LAD/LCXOn examination Vitals stableChest/CVS examination un remarkable

ECG-q waves and t inversion in inferior leadsEcho:infero posterior  hypokinesi,a,LVEF 45%

AG-Patent RCA stentLCX-Prox-mid long 75-80%stenosis,LAD -prox 75%,distal diffuse disease

CAG revealed Patent stent in RCA and lesions in LCX and LADLt coronary hooked with 6F EBU guide catheter,lesion crossed with Sion blue guidewire3X40mm DES deployed in LCX and 3X16mm DES deployed in LAD followed by post dilation with TIMI III flow in both vessels10 hrs post procedure patient developed chest pain with hypotension and ECG revealed ST elevation in V2-V4CAG done revealed blocked LAD and LCXIABP inserted ,guidewire crossed across both LCX and LADThrombosuction done ,TIMI II flow achieved in both the vessels

Stent thrombosis is one of the catatrophic complication of coronary stentingClopidogrel resistance can be seen in around 4-40% of the patientsDual antiplatlets with more potent P2Y12 inhibitor(ticagrelor/prasugrel) is standard of care in multivessel PTCA