Author + information
- Chanikarn Kanaderm1
Patient initials or identifier number
Relevant clinical history and physical exam
A 70-year-old, Thai male.
Presented with typical angina and syncope 4 hours.
CAD risk factors: HT and DLP.
No history of previous stroke/TIA.
Diagnosis: Inferoposterior MI with CHB.
(patient deny fibrinolytic drug)
Refer from community hospital for primary PCI.
BW 62 kg BMI 22.6.
BP 102/76 mmHg, PR 48 /minor regular.
No pitting edema at both legs.
Normal S1S2, no murmur.
Lung: no adventitious sound.
Relevant test results prior to catheterization
• Impair LV systolic function EF 46%
• Anteriorwall and inferior wall hypokinesia
• Mild MR
• No VSR
• Nopericardial effusion
No seen flap in aortic root
Relevant catheterization findings:
• JR 7/4 GD
• Wire: Sion blue
• On temporary pacemaker (intermittent heart block)
• Thrombus Aspiration but?
• Thrombuster II 7Fr couldn't pass the mid-RCA lesion
• Excimer laser 0.9 mm couldn't pass the lesion with Guidezilla
• Changed GD to SAL 1 /7Fr.
• Excimer laser 0.9 mm pass the lesion
• Used Bigger sized of Laser catheter ≥1.4 mm
• Predilate with Balloon NC 3.0x15 mm & Scoreflex 3.5 x 20 mm
• Stent 3.5 x 18 mm 18 atm/30 sec was diploid
PCI to LM-LAD was done with provisional technique and final balloon kissing.
• LM+ TVD (patient deny surgery)
• Larger Filing defect in mid-RCA with distalembolization
Plan for management
A) Balloon dilatation
B) Rheolytic thrombectomy (Angiojet)
C) Excimer laser
D) GP IIb/IIIa IV drip and Consult CVT