Author + information
- Sridhar Kasturi1
Patient initials or identifier number
Relevant clinical history and physical exam
A 57 years old male known hypertension, diabetic presented with complaints of chest pain since few days,Coronary Artery Disease Unstable Angina,Post percutaneous coronary intervention was done to Left Anterior Descending coronary artery in 2002, 2D Echo revealed Mild Left Ventricle dysfunction with Ejection fraction was 48%,Coronary Angiogram revealed Double Vessel Disease.
Relevant test results prior to catheterization.
Relevant catheterization findings
Coronary Angiogram revealed Left Anterior Descending Coronary Artery-Mid In Stent Restenosis 70-80% long segment lesion, left circumflex artery Ostium 90% lesion.
LMCA engaged with XB 3.5-7Fr guiding catheter,Coronary Angiogram revealed Left Anterior Descending Coronary Artery-Mid In Stent Restenosis 70-80% long segment lesion, left circumflex artery Ostium 90% lesion. 0.014″ BMW wire was kept in LAD,Pre procedure IVUS showed Large amount of calcium around 280 degree. Plan rotablation followed by LMCA to LAD and LCX stenting with DK-Crush technique.Rota floppy wire was kept in LAD,Rota Floppy wire was kept in LAD and Rotablation done with 1.5 Rota Burr,LAD predilatation done with 2.0 x 12 mm Mini Trek,2.5 x 10 mm Tazuna balloons,LCX predilatation done with 2.5 x 10 mm Tazuna, 2.5 x 10 mm Tazuna kept in LAD across LMCA then LCX stenting done with 2.75 x 16 mm Synergy stent,LCX stent balloon removed and LCX was crushed with 2.5 x 10 mm Tazuna, LCX Post dilatation done with 2.0 x 12 mm Tazuna,The first kissing balloon dilatation done with 2.75 x 12 mm Mini Trek in LCX, 3.5 x 12 mm NC Trek in LAD.Again LAD ISR predilated with 3.0 x 12 mm mini trek balloon,Mid LAD stenting done with 3.0 x 38 mm Synergy Stent. LMCA to LAD stenting was done with 3.5 x 16 mm Synergy Stent,Final kissing balloon dilatation done with 2.75 x 12 mm NC trek (LCX), 3.5 x 12 mm mini trek balloon (LAD),POT of LMCA done with 4.5 x 12 mm Europha NC Balloon, Post procedure IVUS showed well apposed stent struts,The final result was good with TIMI-III flow without any complications.
ISR of LAD due to neoatheroscleorosis associated with calcification which can be treated with IVUS guided ROTA stenting.
IVUS was used for optimization of PCI to get the best possible short term and long term results.
DK-Crush stenting of LMCA was done due to better long termresults in the DK-Crush study.
Synergy stents was used due to favorable data from recentlyreported studies.