A 66years old female presented with c/o chest pain for duration of 1 day
H/o of profuse sweating ,chest pain radiating to back andshoulder ,pain lasting for more than 20 mins, breathlessness gradual in onsetprogressive in nature , grade iii nyha, history of orthopnea + no pnd, patient is diabetic and hypertensiveon regular medication ,no similar episodes in the past
O/e vitals within normal limits Rs : b/l crepts Cvs s1 s2 heard Cns: normal
Routine bloodinvestigations – Normal Troponin-T Positive Echo – Mild apical hypokinesia -EF 45% -No MR
CAG: LAD - Type IIIlarge size vessel & shows 95% Eccentric, calcified lesion at proximalsegmentLCX - Small sizevessel & shows diffuse disease.
RCA - Small sizevessel & shows diffuse disease.
Femoral approachGuiding catheter 6f jl 3.5 Guide wire 0.014 choice pt extra support. Predilated with 2.5 x 15 mm balloon. Femoral approach Guiding catheter 6f jl 3.5 Guidewire 0.014 choice pt extra support Pre dilated with 2.5 x 15 mm balloon. Attempted withdrawal Stent dislodged from balloon into left- main coronary artery. Second guide & wire fromcontralateral femoral, Stent snaired out Successful coronary angioplasty using another stent Patient discharged after three days.
Patient againpresented with chest pain - AWMI. Gross LVF, Echo – Dilated LV- Hypokinesia ofapex and anterior wall- Moderate MR- EF 20%.Coronary Angiography – LAD thrombus Re-Angioplasty Done Under Cover Of Inj. Reoprot. Wire Crossed, ? Through Stent Struts Second Wire Crossed Difficult Balloon Crossing. High Pressure Dilatation
Never withdraw the stent, Deploy there only, Carefulwithdrawal of stent in calcified vessel with proper alignment of guiding. Tryto withdraw stent, guide wire and guiding catheter as a total assembly. Snaringof stent from Left Main Coronary Artery technical expert required. Contralateral femoral puncture and simultaneous wiring if vessel goes into threaten occlusion beforeretrieval of previous wire. As previous wire will help in easy tracking down ofadditional wire. Double wire criss-cross technique. Crush the stent againstwall with another stent. Sub acute stent thrombus need aggressive management.