Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 79-year-old female with cellulitis was taken to our hospital due to fever up and shortness of breath.
RR 24 /min, HR 90 bpm, BP 105/66 mmHg, SpO2 92% (Room air), BT 38.2°C.
Her left leg had inflammation.
Relevant test results prior to catheterization
ECG showed ST-depression: 0.1 mV in V2-6.
Echocardiogram showed reduced ejection fraction, left ventricular dilatation, and mitral regurgitation.
Elevated cardiac enzymes.
Chest X-ray showed pulmonary edema and cardiomegaly.
Relevant catheterization findings
•RCA #1 CTO
•LCX #11 CTO
•LMT 50% LAD #6 50%, #7 90%
1st PCI to RCA#1 CTO
•rt TBI 7Fr Mach-1 AL 0.75 STSH
lesion cross using corsair and XT-R, Gaia 2nd. Pre-POBA to the lesion with SC Sapphire 1.0 x 5.0 mm and 1.5 x 5.0 mm, but couldn't disappearance indentation so use NC Hiryu IB 1.25 x 6.0 mm and Tazuna 2.0 mm (from #2 to #1).
DES Xience Alpine 3.0 x 18 mm-2.5 x 28 mm. final angio was TIMI 3 and no complication.
2nd PCI to LAD#7
•lt TBI 7Fr Mach-1 CLS 3.5 SH
Lesion cross using sion, Pre-POBA to the lesion with SC Sapphire 2.0*10mm and protect D1 with Runthrough NS. Then next pre-POBA with Hiryu 2.25 x 6.0 mm. Delivery DES Xience Alpine 2.5 x 23 to the lesion but couldn't so buddy wire solved through there. and additional stent Xience Alpine 3.0 x 23 mm had put on LAD #6 mid.
In this procedure, made dissection to LMT so stenting Xience Alpine 3.0 x 23 mm. Final angio was TIMI 3 and no complication.
In frail patient, with triple vessel disease, we would like to discuss the strategy of PCI including access site, mechanical support, and procedural step.
In this case, LAD was donor artery to RCA and LCX.
So what is the better strategy?