CASE20240808_001
Nightmares in Remote Area Including Low Resource Setting Cath Lab: LM in Hands of ‘ASUR’
By Bishnu Pada Saha, MIr Jamal Uddin
Presenter
Bishnu Pada Saha
Authors
Bishnu Pada Saha1, MIr Jamal Uddin2
Affiliation
Shaheed Sheikh Abu Naser Specialized Hospital (SSANSH), Bangladesh1, National Institute Of Cardiovascular Disease (NICVD), Bangladesh2,
View Study Report
CASE20240808_001
Complication Management - Complication Management
Nightmares in Remote Area Including Low Resource Setting Cath Lab: LM in Hands of ‘ASUR’
Bishnu Pada Saha1, MIr Jamal Uddin2
Shaheed Sheikh Abu Naser Specialized Hospital (SSANSH), Bangladesh1, National Institute Of Cardiovascular Disease (NICVD), Bangladesh2,
Clinical Information
Relevant Clinical History and Physical Exam
History: A 52 years old gentle man presented with recurrent exertional chest discomfort, palpitation, dyspnea and tiredness that alleviated at rest and taking sublingual nitroglycerine. He has a history of DM for 13 years and hypertension for 8 years with taking irregular anti diabetics and anti hypertensive medication. He is current smoker for last 29 years. He has a family history of ischemic heart
CAG.docx
disease.
Physical examination: Pulse-88/min, BP-175/100 mm of Hg.
CAG.docxRelevant Test Results Prior to Catheterization
Hemoglobin- 71%, random blood sugar-17.3 mm of Hg, Urine for ketone body-negative, S . creatinine- 0.9 mg/dl, fasting lipid profile- near normal, CRP-normal, Chest X-Ray-normal,ECG & Echo-normal but ETT strongly positive during 2nd stage with chest pain and ST change.All the viral marker-negative.
CAG.docx
CAG.docxRelevant Catheterization Findings
CAG findings:
LM Distal –Minor plaque plaque extending toLAD and 95% stenosis in osteo-proximal LASD LCX-Normal RCA-Normal caliber , dominant and Diseasefree.
Syntax score-12
CAG.docx
LM Distal –Minor plaque plaque extending toLAD and 95% stenosis in osteo-proximal LASD LCX-Normal RCA-Normal caliber , dominant and Diseasefree.
Syntax score-12
CAG.docxInterventional Management
Procedural Step
Planned for PCI to LM-LAD through right distal radial.
PROCEDURE.pptx
Wired both LAD & LCX after engagement of 6F EBU guide catheter.
Pre dilatation was done with 2x12 mm semi-complaint balloon at LM distal to osteal LAD then LM Dissection occurred.
After prepared bed 3.5x28 mm DSE was deployed LM ostia to proximal LAD at 14 atm.
Unfortunately again dissection occurred at LCX.
So we planned PCI to LM-LCX (T-stenting).
POT was done distal LM with 4.5x8 mm NC balloon.
Then 3.5x30 mm DSE was deployed in LCX at 14 atm.
KBI and FKBI to LAD and LCX was done.
And finally IVUS was done.
PROCEDURE.pptxCase Summary
ØLMPCI is itself complex procedure and complication are also fatal.
ØTreatmentdecision should depends on each patient & each lesion.
ØInbifurcation lesion , provisional single stent strategy is still the defaultapproach
ØComplication of PCI management requires preparation ,early recognition
& knowledge of effective techniqueswith good team effort.ØOstial branch lesion does not come alone, usually involve main branch.
ØCarefulmanipulation of guide catheter is required especially ostial LM PCI.
ØImaging(IVUS) is very helpful .