CASE20220809_004

A Case of Calcified LAD with Acute MI, Primary PCI done with IVL and Perforation of Septal Artery

By Rohit Mody
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Presenter

Rohit Mody

Authors

Rohit Mody

Affiliation

Adjunctive Procedures (thrombectomy, artherectomy, special balloons) - Adjunctive Procedures

A Case of Calcified LAD with Acute MI, Primary PCI done with IVL and Perforation of Septal Artery

Rohit Mody

Clinical Information

Patient initials or Identifier Number

235232

Relevant Clinical History and Physical Exam

a 77 Year old Male, who is Diabetic Hypertensive Normal Body mass index STEMI anterior wall Ejection Fraction 30% Cardiogenic shock LVF, Family history of Coronary artery disease, smoker, non drinker,

Relevant Test Results Prior to Catheterization

ECG showed STEMI anterior wall Ejection Fraction 30%, Troponin Positive

Relevant Catheterization Findings

Angiography reveals- LAD 100% at ostium with Acute MI

Interventional Management

Procedural Step

LM Hooked with EBU 3.5 6F tried crossing with Workhorse wire but couldn’t cross so upgraded to Fielder FC wire, Type 4 Perforation occurred at Distal septal, Using Prograde Microcatheter Coils were deployed at the site to seal the Perforation Pre-Dilatation done with 2.0x12mm Balloon Fielder FC wire changed with Floppy wire, , Mid LAD was CTO so tried to cross with Balloon Support, Proximal portion was Pre-Dilated with 2.5x12mm balloon Proximal LAD was calcified so IVL done and 40 pulses of shock was given using Shockwave catheter. 3.0x28mm DES Deployed at 20 ATM, Mid LAD was a CTO & tried crossing with a stiff wire and looking at the patient’s condition it was decided to do only proximal stenting as Distally it was filling retrogradely, The proximal stent expansion was adequate & TIMI 3 Flow achieved in the proximal segment.

Case Summary

In Acute MI the proximal portion supplying to Diagnols and septals can be lifesaving as primary PCI. Septal Perforations are Type 4 Perforations and can be sealed antegradely Retrograde injection must be taken to see if it is leaking from retrograde side also, If so Retrograde sealing is also required. IVL use can be helpful in Calcified lesions even in the setting of Acute MI with clot as in our patient leading to final good expansion of stent without slow flow.