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High-Risk Intervention (diabetes, heart failure, renal failure, shock, etc) - High-Risk Intervention
Revascularization for CHIP : Low LVEF Patient with CTO Calcified and LM Bifurcation Disease
Yongbai Luo1, Ning Guo1
The First Affiliated Hospital of Xi'an Jiaotong University, China1,
[Clinical Information]
- Patient initials or identifier number:
-Relevant clinical history and physical exam:
Male 62yrs, was hopitalized by exertional chest discomfort for 10 yrs, aggravated for 3 months.
CHD risk factor: current smoker
PE: Bp 94/58mmHg, HR  85bpm
CAG was peformed in other hospital and showed multivessel disease, the patient refused to received CABG     

-Relevant test results prior to catheterization:
Pro-BNP 2290pg/mL
c-TnT  0.017ng/ml(0-0.014)
Echo : LVDd/LVDs 61/54mm LVEF 22%
- Relevant catheterization findings:
LAD: diffuse and calcified lesion 
Diag&LAD: Medina 1,1,1 bifurcation disease
pLCX: total occlusion 
mRCA: total occlusion

[Interventional Management]
- Procedural step:
CABG was refused by Surgeon as low LVEF, so we performed CCTA to understand the detail of coronary anatomy and develop PCI strategy. Firstly ,we opend the right coronary artery with antegrade wire escalation technique, then with the Impella support, we performed rotablation for LAD calcified disease, then checked IVUS to make sure that calcified lesion was modified well,then we  implanted 2 stents with balloon-stent kissing technique to treat LAD and Diagonal bifurcation. Finally, we opened the LCX, and perform DK-crush to treat LM to LAD and LCX bifurcation.

- Case Summary:
Completed revascularization is very important for patients with HFrEF, usually CABG, sometimes PCI.Careful analysis of image is key to success of CTO PCI.Ventricular assistant devices such as ECMO/IABP/Impella are critical for CHIP PCI.Intra coronary imaging can provide more information and optimize result.

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