ACS/AMI - ACS/AMI
STEMI With a Midway Stone
Choutchung Tinakorn Na Ayudhya1, Suphot Srimahachota2
Faculty; Interventional cardiology Division of Cardiovascular Medicine, Department of Medicine, Facu, Thailand1, King Chulalongkorn Memorial Hospital, Thailand2,
A 65 year old female without known underlying disease. She was an active smoker. She presented with acute typical angina at rest for 4 hours PTA without orthopnea or PND. At ER ECG 12 leads showed sinus rhythm rate 90/min with ST elevated in V1-V4. STEMI fast track was activated. Physical examination showed BP 112/90 mmHg, HR 90/min RR 16/min, RS no crepitation, CVS normal S1S2 no murmur. She received ASA gr V 1 tab and Ticagrelor (90) 2 tabs and Heparin 4500 units IV and was sent to cath lab
STEMI patient may had acute ontop of chronic lesion even though patient had no underlying disease. Multiple methods may be required to correct balloon/ stent uncrossable lesion such as increase guiding support, buddy wire and guide extension. Calcified lesion with contraindication for rotational atherectomy such as evidence of dissection, balloon based approach is still doable.