-This is a complex high risk patient, in Cardiogenic shock Preferably to be done on mechanical circulatory support.- Impella is not available.
- The whole 4 IABPs in our centre are already busy on other patients.
ü Tackle RCA first .. If failed .. Postpone PCI till secure an IABP / CABG
ü Provisional stenting strategy
ü PCI to LCX using TAP technique as a bailout
- Bifemoral access
- PCI to RCA
- Lesion passed with a regular workhorse wire. Predilatation, followed by two DESs (2.5 x23mm) overlapped with (2.75x38mm) Post dilatation using NC balloon(2.75x15mm)
- Predilatation to the LM with compliant balloon (2.5x15 & 2.75x15) both ruptured.
- Another predilatation with NC balloon(3x12mm) at 14 atm.- PCI to mid LAD, DES(2.75x30) and Post dilatation with NC balloon ( 3x15mm)- PCI to LM-LAD cross over the LCX with DES (3.5 x 38mm), flaring at the ostium.- POT with NC balloon (4.5 x 12 mm)
- PCI to LCX- Wires were recrossed, the side strut was opened using balloon (2 x 20mm) followed by kissing balloon inflation >>haziness at LCX ostium.- PCI to LCX with DES (2.75 x 23 mm) TAP technique- Kissing balloon inflation followed by final POT.
> IVUS- Well opposed stent, MLA = 7.5 mm2 at the LAD and 10 mm2 at the distal LMT