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Patient initials or identifier number
Relevant clinical history and physical exam
A 60-year-old male, with a history of Type 2 DM, Hypertension had presented with a 1-week history of effort angina progressing to rest angina. His ECG was unremarkable and Echocardiography was essentially normal.
Relevant test results prior to catheterization.
Relevant catheterization findings
CAG showed significant mid shaft LMCA disease.
A 3.5 EBU catheter was used, 0.014 BMW wire crossed to LAD, a 3.5 x 12 DES was positioned across LMCA and dilated at 16 atmospheres. Post dilatation with 4.0 x 8 non-compliant NC balloon at 16 atmospheres showed good result. A run of OCT was done across the LMCA- LAD, the stent in LMCA showed not well-apposed stent hence OCT was removed and a 4.5 x 9 non-compliant NC balloon was crossed across stent and well post-dilated. A final run of OCT showed well post dilated stent struts, there was no carinal pinch and no hemodynamic abnormalities.
Though LMCA mid shaft stenting may look easy but a dissection look alike lesion can give many worries, quick stenting with a backup of OCT guidance and post-dilatation can indeed give good results.