High-Risk Intervention - High-Risk Intervention (Diagetes, Heart Failure, Renal Failure, Shock, etc)
Successful Left Main Coronary Artery Stenting in Very High-Risk Non-st Segment Elevation Myocardial Infarction
Sandi Sinurat1, Markz Sinurat2, Daniel Parningotan Tobing3
Eka Hospital Cibubur, Indonesia1, Korea University - Guro Hospital, Indonesia2, National Cardiovascular Center Harapan Kita, Indonesia3,
Chest X-Ray: Bilateral Infiltrate: pulmonary edema dd/ pneumonia
Diagnostic coronary angiographyshowed total occlusion of left main (LM) coronary artery, diffuse significantstenosis of ostial-mid left anterior descending (LAD), significant stenosisostial, multiple stenosis in proximal-distal left circumflex artery (LCx),intermediate stenosis in distal right coronary artery (RCA). We observed Rentropgrade 2 collateral from distal RCA into LAD. We decided to perform angioplasty usingXB 3.5/6Fr guiding catheter. Run-through wire to intermediate vessel. We wiredLM-LAD lesion with Sion Blue, and after several times we can cross the lesionand deliver the wire to distal LAD. We did the pre-dilatation of LM-LAD withEverest 2.0/10mm and escalated to 2.5/15mm until 14atm. Lesion opened withvisible 80-90% stenosis of LM, visible thrombus. We decided to do directstenting with Coroflex Isar Neo 3.0/32mm in distal LM-proximal LAD. Post-dilatationusing NC Force 3.5/10mm until 16atm was delivered, resulting in TIMI 3 Flow andno thrombus. After several minutes, He developed unstable hemodynamic withhypotension and ventricular tachycardia. We cardioverted him, escalated thevasopressor and inotropic and decided to re-evaluate the coronary vessel.Angiography evaluation showed re-thrombosis in intraluminal stent. Re-wiring todistal LAD and manual defragmentation of thrombus using NC Force 3.5/10mm wasdone successfully. Final angiography showed TIMI 3 flow with no thrombus. Hemodynamicwas improved, monitor showed sinus rhythm. post rewiring thrombus final angio.wmv Post PCI LM-LAD.wmv Post POBA LM-LAD.wmv
The challenge of left maincoronary artery stenting encapsulates the intricate nature of interventionalcardiology. Navigating anatomical complexities, procedural nuances, andpatient-specific factors presents a formidable task. This case reportunderscores the urgent need for rapid and precise interventions when facingcomplex and life-threatening scenarios. Immediate resuscitation, seamlessteamwork, and advanced and experienced intervention cardiologist and techniquesled to the restoration of blood flow, ultimately reviving cardiac function.