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Relevant clinical history and physical exam
This 64 years old female had the history of angina pectoris with CAD, dyslipidemia, and hypertension. She suffered from intermittent chest tightness for several months and ever visited our CV OPD for evaluation 2 years ago. The thallium scan showed myocardial ischemia over an anterior wall. However, she suffered from still intermittent chest tightness recently after medication, occurred on exertion and subsided after resting and improved after NTG use. We arranged cardiac catheterization for the patient.
Relevant test results prior to catheterization
Thallium scan showed myocardial ischemia over anterior wall.
12-lead ECG showed T wave inversion over V2-V4.
Relevant catheterization findings
Cardiac catheterization showed CAD/1-V-D (LAD) with a white-ball lesion at LAD-P and significant stenosis at LAD-M.
1. The diagnostic cardiac catheterization showed CAD/1-V-D(LAD) with white-ball lesion over LAD-P and significant stenosis over LAD- M (reference angio 1 and 2). We decided to do PCI for the lesions of LAD-P and LAD-M.
2. We used the both image tool of IVUS and OCT to evaluate LAD and the lesions (see IVUS 1 and 2 and OCT 1)
3. Under the guiding catheter of EBU4.0, 6Fr support, the GW of Asahi Sion blue cross the lesions of LAD-P and LAD-M and we use balloon of Maverick (3.0 x 20 mm) with maximal 10 bars at LAD-Pand 6 bars at LAD-M but without change of the white-ball lesion.
4. Under the Guidelinear 5.5Fr extra-support, we use the cutting balloon of Flextome (2.75 x 10 mm) with maximal 10 bars at the site of white ball site of LAD-P (reference angio 3)
5. Then we put DES of Resolute Integrity(3.0 x 38 mm) from LAD-M to LAD-P and coronary angiogram post-stenting revealed still residual stenosis(reference angio 4 and 5). We use the balloon of NC Quantum Apex (4.0 x 8 mm) todilate LAD-P lesion with maximal 14 bars (reference angio 6)
6. Coronary angiogram post-dilatation reveals less residual stenosis and we close the procedure(reference angio 7)
In this case, image studies showed calcified lesion at proximal LAD and unstable plaque lesion at middle LAD. So Image studies before PCI provide more understanding to help us decide which lesion needs to be treated and how to treat the different LAD lesions.