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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,|
- 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:
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
- 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.