E-Science Station

Complications - Complications
Nightmare in Cath-lab - Patience is the Real Player
Mahmood Hasan Khan1, Shahab Uddin Talukder2, Aqm Reza2
Evercare Hospital Dhaka, Bangladesh1, Apollo Hospitals Dhaka, Bangladesh2,
[Clinical Information]
- Patient initials or identifier number:
-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
[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
´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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