E-Science Station
E-Science Station
CASE20200924_002
| Complications - Complications | |
| Nightmare in Cath-lab - Patience is the Real Player | |
| Mahmood Hasan Khan1, Shahab Uddin Talukder1, Aqm Reza2 | |
| Evercare Hospital Dhaka, Bangladesh1, Apollo Hospitals Dhaka, Bangladesh2, | |
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[Clinical Information]
- Patient initials or identifier number:
KAA
-Relevant clinical history and physical exam:
´Mr. KAA ´Age: 61 years ´Gender: Male ´Risk Factors: Diabetes, Hypertension ´Admitted as a case of Acute Inferior ST Elevated - ACS. ´ECG: Acute MI (Inferior) with Anterior Ischaemia ´Echo: RWMA (+) with LVEF: 30% & WMSI: 1.41 -Relevant test results prior to catheterization:
Hb--> 12.3 gm/dl
TLC--> 9600/ cmm Na--> 135 mmol/L K--> 4.1 mmol/L - Relevant catheterization findings:
Ø Triple Vessel CAD. ØRCA:100% occluded from proximal segment. ØLAD:70-80% multiple lesions at proximal- mid segments. Ø LCx: 60% concentric plaque at proximal segment. Ø Recommended for Primary PCI to RCA & Stage PCI to LAD |
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[Interventional Management]
- Procedural step:
´Route Used: Left Femoral ´Guide Catheter: JR6F ´Vascular Access Sheath: 7F & 14F ´Guide Wires: Teremu 0.035“ x 260 cm Exchange wire Floppy´Andra 20 mm Snare Left femoral access was done. A JR 6F guide catheter was used with 7F & 14F vascular access sheaths were taken. The broken sheath part was accessed with Teremu 0.035" x 260 cm exchange wire & Floppy wires. Then a snare was introduced through the sheath & the broken sheath was caught by the snare and it was taken out from the body slowly & carefully. The total procedure was uneventful. - Case Summary:
´Complications are the lessons for the interventionists. ´Complication management is a great challenge. ´Planning is essential. ´Perseverance is mandatory. ´Need to have all kinds of hardwires in the shelve. ´Last but not the least patient must get the priority above all. |
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