A 79 year-old-man with underlying diseases of hypertension, hyperlipidemia and dementia presented with dyspnea on exertion and intermittent chest tightness for 2 monthsAfter thorough physical examination, his lung was clear and his heart had no murmur.
His chest x-rays showed cardiomegaly with normal lung parenchyma. His ECG showed sinus rhythm with T-wave inversion in lead II, III, aVF and ST depression in lead V4-6.Other blood examination tests were in normal range.Cardiac MRI exhibited that LVEF was impaired with 40% and there were severe hypokinesia of anterior, anteroseptal, inferosetal, and inferior wall from apical to basal segment. Besides, there was no late gadolinium enhancement which meant all segments were viable.
CAG was done and shown as below.
LM : No significant stenosis
LAD : 80-90% calcified stenosis at proximal to mid LAD with bifurcation of 70% stenosis ostial DG1
LCx : 90% calcified stenosis at proximal part followed by 90% long stenosis distal part.
RCA : Nodular calcium causing 90% stenosis ostial RCA followed by CTO distal PLB received collateral flow from left coronary system
In conclusion, the patient had tripple vessel disease and desired to be revascularised with PCI rather than CABG. cine1.mp4 cine2.mp4 cine3.mp4
A 79 year-old-man presented with chronic coronary syndrome and his angiogram showed TVD with calcified lesion. Firstly, we tried to do PCI at proximal RCA but accidentally, the catheter was twisted and kinked. We used the snare via transradial artery to grab the tip of catheter in order to fix it and be able to untangle the proximal part. Finally, we can finish the PCI of RCA with good results without further complications.