Case Review Katrine Zhiroff, MD USC Keck School of Medicine Los - - PowerPoint PPT Presentation

▶
case review
SMART_READER_LITE
LIVE PREVIEW

Case Review Katrine Zhiroff, MD USC Keck School of Medicine Los - - PowerPoint PPT Presentation

Feb 20, 2023 196 likes •617 views

Case Review Katrine Zhiroff, MD USC Keck School of Medicine Los Angeles, CA Disclosures: Biotronik (consulting) Terumo (consulting) Abiomed (consulting) Novartis (speakers bureau) Clinical Cases Deliverability

slide-1
SLIDE 1

Case Review

Katrine Zhiroff, MD USC Keck School of Medicine Los Angeles, CA

slide-2
SLIDE 2

Disclosures:

▪ Biotronik (consulting) ▪ Terumo (consulting) ▪ Abiomed (consulting) ▪ Novartis (speakers’ bureau)

slide-3
SLIDE 3

Clinical Cases

  • Deliverability
  • Pushability
  • Side Branch Access
slide-4
SLIDE 4

Case

  • 67 year old woman with long-standing hypertension
  • Presents with crescendo angina x 2 months, now with <1/2 block
  • Unstable angina with rest pain relieved by NTG gtt
  • ECG: sinus rhythm with dynamic T wave inversions in II, III, aVF, V3-6
  • Echo: EF 70%, LVH, no wall motion abnormalities
  • Home Medications: HCTZ, amlodipine
  • Labs
  • Creat 0.86, TnI<0.01
  • Total Chol 211, TG 172, LDL 139, HDL 38
slide-5
SLIDE 5
slide-6
SLIDE 6
  • Right radial artery 6Fr Slender
  • 6 Fr JL 3.5 guide
  • FFR of ostial LAD 0.79
  • PTCA with 3.0x12 mm Emerge
slide-7
SLIDE 7

4.0x16 mm Orsiro stent

slide-8
SLIDE 8

Post dilated with 4.0 mmx12 mm Emerge NC IVUS: good expansion and apposition of stent in ostial LAD

slide-9
SLIDE 9

Resting FFR 0.8 across mid LAD

slide-10
SLIDE 10
slide-11
SLIDE 11

Predilated with 3.0x12 mm Emerge

slide-12
SLIDE 12

Orsiro 3.5x24 mm

slide-13
SLIDE 13

Overlapping distal Orsiro 3.5x13 mm

slide-14
SLIDE 14
slide-15
SLIDE 15

Case

  • 72 yo man with history of CAD, ischemic cardiomyopathy, ongoing tobacco abuse, chronic kidney disease (Cr

1.5)

  • Ischemic CM, EF 35%
  • 4v CABG and bioprosthetic valve replacement 1990s in Philippines
  • LIMA to LAD, SVG to D1, SVG to OM1 sequential OM2, SVG to RCA (100%)
  • h/o CHB, s/p PPM
  • Prior PCI of ostial RCA (Xience) and OM (Absorb) in 2016
  • Presented with unstable angina at OH in Guam
  • Attempted PCI of LCx, however, unable to deliver equipment
  • Presents for elective revascularization
  • Currently angina with ADLs
slide-16
SLIDE 16
slide-17
SLIDE 17
  • Right radial artery access
  • 6 Fr Slender sheath
  • 6 Fr Q4 Guide catheter
  • 0.014” Whisper Extra Support
slide-18
SLIDE 18
  • 0.014” PT2 Moderate Support
  • Emerge 2x12 mm PTCA
slide-19
SLIDE 19

Emerge 2x12 mm PTCA

slide-20
SLIDE 20
  • IC Adenosine (2x 25 mcg)
slide-21
SLIDE 21

Orsiro 2.75 x 13 mm Post dilation with 2.75x8 mm Emerge NC

slide-22
SLIDE 22

Orsiro 2.75x15 mm Post dilated with 2.75x12 mm Emerge NC

slide-23
SLIDE 23

Orsiro 2.75x30 mm

slide-24
SLIDE 24
slide-25
SLIDE 25

Case: Courtesy of Dr. Juan F. Iglesias MD FESC

Geneva University Hospital, Switzerland

  • 71 yo male patient, former pilot of the UK Royal Air Force
  • Risk factors: hypertension, dyslipidemia
  • No relevant past medical history
  • Current presentation: 1 hour ongoing typical central chest pain,

shortness of breath

  • ECG: anterior STEMI
  • Transferred to catheterization laboratory for primary PCI
  • Haemodynamical instability, cardiogenic shock, extreme agitation
  • Oro-tracheal intubation, pharmacological resuscitation
slide-26
SLIDE 26
slide-27
SLIDE 27

Manual aspiration thrombectomy

slide-28
SLIDE 28

VF arrest , CPR Pantera Leo 3x15mm @ 14 atm

slide-29
SLIDE 29

IABP Insertion

slide-30
SLIDE 30

Orsiro 3x15mm @12 atm in mid LAD Orsiro 4.0x22mm @ 12 Atm LM-prox LAD

slide-31
SLIDE 31

Pantera Leo 4x12mm @ 18 Atm LM-LAD Orsiro 3.5x22 mm @ 14 atm LCx

slide-32
SLIDE 32

Orsiro 2.75x25mm @ 14 atm LCX

slide-33
SLIDE 33

Final Kissing Ballon LAD-LCx with Pantera Leo 4x12 LAD and 3.0x12 LCx @ 14 Atm

slide-34
SLIDE 34

Final angiographic result

slide-35
SLIDE 35
  • 64 yo male patient.
  • Risk factors: hypertension, dyslipidaemia, ex-smoker.
  • Past medical history:
  • GOLD stage 2 COPD
  • PAD
  • CAD with prior PCI to RCA (1 DES) 3 years ago.
  • Current presentation: 2-month history of typical exertional angina and new-onset shortness of

breath on exertion.

  • Cardiac MRI: preserved LV systolic function, antero-septal, anterior and anterolateral walls

reversible myocardial ischaemia, no myocardial infarction.

  • Medication: Aspirin, Irbesartan, Metoprolol, Atorvastatin.

Case: Courtesy of Dr. Juan F. Iglesias MD FESC

Geneva University Hospital, Switzerland

slide-36
SLIDE 36
slide-37
SLIDE 37

PANTERA PRO 2.0 x 15 mm @ 12 atm (D1)

slide-38
SLIDE 38

EBU 3.75 6Fr Guiding catheter Sion Blue and Sion Blue extra support guidewires (buddy wire technique) Xience 2.25 X 8 mm Orsiro 2.25 X 9 mm

slide-39
SLIDE 39

ORSIRO 2.25 x 9 mm @ 12 atm (D1)

slide-40
SLIDE 40

Orsiro 3.0 X 35 Mm (Proximal To Mid Lad) Kissing Balloon Lad-D1 Pantera Lux DEB 2.0 X 20 Mm (D2)