This45 year old gentleman- a known case of old AWMI (post PTCA to LAD in 2011)presented to us with severe retrosternal chest pain &dyspnoea a/w sweating for last 3 hours. The patient wasin Killip Class IV with cardiogenic shockand recurrent VT.
vECG: LBBB, Diffuse ST depressionin all leads except aVR & V1 & ST elevationin I,aVL & aVR
v2 DEcho suggestive of severe LV Systolic Dysfunction( LVEF-20%),SevereMR, Moderate TR ,Moderate PAH
The patient was taken for Urgent CAG withintent to primary angioplasty.
Coronary angiography suggested critical LM stenosis with significant ISR of LADstent in proximal part.
Patient was put on Intra-aortic balloonpump.
JL 3.5- 7F guiding catheter was engaged inleft cusp near LM ostium
After crossing the lesion & serial predilatation with semicompliant balloons, 4.0x 23 Xience Prime DES was implanted from LM to LAD covering the ISRsegment.Post dilatation with proximal optimization was done using4.5x 8 mm NC sprinter balloon