Author + information
- Navreet Singh1
Patient initials or identifier number
A 75 years old male with ACS
Relevant clinical history and physical exam
• Patient SS 75 years of age presented with ACS
• ST Elevation aVr
• EF 45%
• On going pain, cardiogenic shock
Relevant catheterization findings
• LMCA:- Calcific, Normal
• LAD: Calcific,99% Diffuse disease
• LCX: 99% Diffuse disease
• RCA: Dominant, 90% mid RCA disease
• PCI to LAD & LCX. Hooked with JL3.5, 6F abd Fielder XT GW was used to cross the LAD. Balloon was difficult tocross but managed, and predilatation with 1.5 x 15. 2 x 10, 2.5 x 15 mm semi compliant balloon. Endeavor Sprint 2.75 x 30 mm deployed in LAD & post dilated with 3 x 12 mm NC balloon.
• PCI to LCX .Hooked with JL 3.5, 6F and Whisper GW use to cross the lesion. BDC was difficult to cross, but managed distal to proximal predilated with 1.5 x 15, 2 x 10 mm semi compliant balloon.
• Endeavor Sprint 2.5 x 14 mm did not cross the distal lesion. On removing the stent it was noticed that the stent got dislodgement in LMCA. We tried passing a smaller balloon but it did not cross. We the decide to plaster the stent with LMCA wall. We did so by passing another GW (Cruizer) & serially dilating the LCX & LMCA. Resolute Integrity 2.5 x 14 mm passed distally. Proximally Endeavor Sprint 2.5 x 14 mm tried but it did not cross. The whole assembly prolapsed into aorta & a EBU used for better support. The LAD was needed to be secured so a wire passed and aNC 4.5 x 12 mm balloon was used to plaster the LMCA stent to the wall.
• LCX rewired but smallest balloon was not passing across the ostium.
• No further intervention was thought possible and patient maintained on anticoagulant & IABP.