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Patient initials or identifier number
Relevant clinical history and physical exam
A 50 years old male who suffered from colds sweating and chest pain followed by transient consciousness loss in early morning– visit CV OPD. A-V dissociation was noted in 12-leads EKG– referred to ER (troponin-I=9.2 ng/mL).
Relevant test results prior to catheterization
EKG: A-V dissociation with possible slow VT
Elevated troponin-I level = 9.2 ng/mL
Relevant catheterization findings
LAD: Luminal irregularities
LCx: LCX-P: 80% stenosis; LCx-D: 85% stenosis
RCA: RCA-P-M: long tandem lesion 60-70% narrowing.
RCA-M: Total occlusio
After recognizing RCA as being infarct-related artery, we paid PCI for RCA.
1. SiON- Blue wire to RCA-D successfully and was followed by thrombuster aspiration to and fro from RCA-M to RCA-D.
2. After serial predilatation by 2.0/15 mm, 3.0/20 mm semi-complaint balloon, we restored RCA's distal flow.
3. Confirming vessel size by IVUS, we deployed 2,5/38 mm DES, 3.0/38 mm DES and 3.5/38 mm DES from RCA-D to RCA-P.
4. Patient had symptoms of chest pain ans distress after PCI,then we had found of dye accumulation at PDA distal portion and pericardial effusion noted by bed-side echo checking
5. Failure to stop dye stasis even with small-balloon long-inflation
6. We used the thrombus just aspirated from infarct-related artery (RCA), slow and genteelly plugged into Fine cross catheter and pushed it forward with whisper wire to proximity to PDA.
7. Finally stopped PDA distal flow and the amount of pericardial effusion.
• Guide wire perforation and vessel rupture are two basicmechanism of perforation.(EricJ Topolet al.,2011).
• Besides reversal of anticoagulation, prolonged balloon inflation, Coveredstent implantation (PTFE-covered stent), we can treated with delivery ofocclusive coils, fat, beads, gelfoam,polyvinyl alcohol foam or autologousclotted blood in limited perforation . (JasonH.Rogers,MDetal., 2011).
• Facing to cardiovascular disease, thrombus is our devastating and solid foe all the time, ironically, it may played a friend to give a hand in some occasion.