Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 59 years old, male referred from family doctor due to worsening exertional chest pain. His PMH was hypertension and diabetes. As he did not have symptom at rest and took Metformin, I judged that there was not the emergency.
Relevant test results prior to catheterization
On the next day of the hospitalization, we carried out CAG. It seemed that LAD#7 had a slitly 99% stenosis, and LCX#11 had 90% stenosis. Besides, the coronal pulmonary artery fistula from LAD was observed.
Relevant catheterization findings
For confirmation, we did The coronary arteries CT, it showed LAD had stenosis like CAG.
We inserted 6Fr EBU3.75 through right radial artery. SION blue can penetrate target lesion smoothly, then IVUS showed no stenosis at this point. For a change, we did PCI for 2nd target lesion; LCX# 11:90% stenosis. After Showing IVUS, the lumen was occupied fibrous plaque, we detained SYNERGY stent: 3.5 x 24 mm directly, did post dilatation using NCB: 4.0 x 15 mm. After intervention, his symptom disappeared, so culprit lesion seemed to be LCX. For sense, we did Tl myocardial perfusion scintigraphy, it did not showed ischemia.
This case suggested the possibility that Coronary-Pulmonary artery fistula cause loss of contrast. As this case had another stenosis lesion, We were able to keep off a useless invasion. In such cases, It is necessary to take possibility of the overestimate into account.