Author + information
- Satoshi Tobita1
Patient initials or identifier number
Relevant clinical history and physical exam
A case was 61 year-old female. Her past history was hypertension.
She felt a chest pain from yesterday, so consulted a home doctor. She was suspected acute coronary syndrome and transferred to our hospital. In our hospital, her hemodynamics and respiratory condition were stable. There was not the abnormality of the physical exam, but chest pain lasted.
Relevant test results prior to catheterization
ECG showed ST elevated in leads II, III, aVF and V5-6. There was not the abnormality by chest X-rays.
Cardiac echo showed myocardial infarction on the inferior wall, and then emergent coronary angiogram was performed.
Relevant catheterization findings
Emergent CAG revealed total occlusion at left circumflex posterior descending artery (LCX#15) and collateral vessels from the left anterior descending artery to LCX#15. Emergent PCI was performed to LCX#15.
7Fr sheath from the right radial artery.
Guiding catheter: Heartrail II IL3.5 7F.
Guidewire: Run through NS ultra floppy.
Balloon: Apex OTW PTCA Balloon Dilation Catheter 1.5 x 20 mm, Tazuna PTCA Balloon Catheter 2.5 x 20 mm, SeQuent Please Drug Eluting Balloon Catheter 2.5 x 20 mm
1. First, Apex OTW balloon catheter 1.5 x 20 mm with Run through NS ultra-floopy could successfully pass to LCX#15 and dilated the occluded lesion up to 14 atm
2. Good dilatation and TIMI 3 flow were obtained
3. IVUS revealed the vessel diameter was small (ref. 2.0 mm) and diffuse thrombus with a fibrous plaque. Thus we chose ELCA without stent strategy
4. Excimer Laser (VitesseCos, 1.4 mm) could successfully ablate the thrombus and plaque.
5. Long dilatation of Tazuna PTCA balloon Catheter 2.0 x 15 mm was performed to occluded lesion at the LCX#15
6. Paclitaxiel coated balloon 2.0 x 20 mm was used to the lesion
7. We confirmed good dilation by the IVUS and angiography
8. She could uneventfully discharge at 14th hospital day
We experienced a case of STEMI treated by ELCA and PCB without a stent. 3 m-f/u CAG showed no restenosis and good TIMI flow in LCX. ELCA with PCB would be a good choice for the lesion in the small vessel unsuited for stent implantation even in the ACS setting.