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Nov 03, 2022 284 likes •471 views

COMPLEX PERCUTANEOUS CORONARY INTERVENTION FOR ACUTE CORONARY INTERVENTION FOR ACUTE CORONARY SYNDROME IN A PATIENT WITH THORACIC AORTIC ANEURYSM AFTER STENT GRAFT AORTIC ANEURYSM AFTER STENT GRAFT TREATMENT Zu-Yin Chen, MD; Tao-Cheng Wu, MD

SLIDE 1

COMPLEX PERCUTANEOUS CORONARY INTERVENTION FOR ACUTE CORONARY INTERVENTION FOR ACUTE CORONARY SYNDROME IN A PATIENT WITH THORACIC AORTIC ANEURYSM AFTER STENT GRAFT AORTIC ANEURYSM AFTER STENT GRAFT TREATMENT

Zu-Yin Chen, MD; Tao-Cheng Wu, MD Division of Cardiology, Taipei Veterans General Hospital Taipei, Taiw an

SLIDE 2

PATIENT HISTORY

93 y/o man, history of HTN and thoracic aortic aneurysm

dissection, about 10 years ago

Poorly controlled BP for two days
Descending thoracic aorta with mural thrombus, measuring

Descending thoracic aorta with mural thrombus, measuring 8.5cm in diameter

DAA Stent graft insertion was performed smoothly

DAA Stent graft insertion was performed smoothly

SLIDE 3

HOWEVER…

Non-ST elevation myocardial infarction with cardiogenic

shock occurred after unplanned extubation

SLIDE 4

CAG

RAO caudal AP cranial RAO caudal AP cranial

SLIDE 5

AP caudal LAO cranial

SLIDE 6

RCA LAO

SLIDE 7

DIAGNOSIS

CAD with TVD and LM disease
LM bifurcation Medina 1 1 1
LM bifurcation Medina 1,1,1

SLIDE 8

TREATMENT PLAN

CABG vs PCI
Family refused CABG

y

IABP was placed for support

SLIDE 9

LM to distal LAD was predilatated LM to distal LAD was predilatated with a Ryujin 2.5 x 20mm balloon with pressure up to 10barr p p A Ryujin 3.0 x 15mm balloon was A Ryujin 3.0 x 15mm balloon was used to predilatate the lesions from distal LCX to proximal LCX p with pressure up to 6barr

SLIDE 10

DISSECTION

Dissection occurred over

LM to proximal LAD and LM t i l LCX to proximal LCX

Cullote stenting

SLIDE 11

STENT DEPLOYMENT

Mid to distal part of LAD: Proximal to mid LAD: p Xience V 2.75x28mm Xience V 2.75 x 28mm

SLIDE 12

STENT DEPLOYMENT STENT DEPLOYMENT

Distal LCX: Mid-LCX: Promus 2.75 x 28mm Xience V 3 x 28mm

SLIDE 13

CULLOTE STENTING

1 LM to proximal LAD: 2 LM to proximal LCX:

1. LM to proximal LAD:

Xience V 3.0 x 18mm

2. LM to proximal LCX:

Xience V 3.5 x 23mm

SLIDE 14

KISSING BALLOON TECHNIQUE

LM to proximal LAD
NC Mercury 3.0 x 20mm

y

LM to proximal LCX

NC Voyager 3 5 x 15mm

NC Voyager 3.5 x 15mm

SLIDE 15

FINAL SHOT

SLIDE 16

The patient withstood the procedure well and was

transferred to critical care unit for further care

SLIDE 17

CONCLUSION

IABP can be used safely in a patient after thoracic aorta

stent deployment

Measures such as adequate sedation during intubation