Cutting Edge Case Presentation #1

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Presentation transcript:

Cutting Edge Case Presentation #1 H Tam Truong, MD Southern Arizona VA Healthcare System

Disclosure H Tam Truong, MD I have no relevant financial relationships

History 69 year old man who has progressive typical angina for the past month referred for coronary angiogram. PMH: DM2, dyslipidemia, hypertension, obesity BMI 40, BPH Echo: EF 60%, no significant valvular disease

Coronary Angiogram

Zoomed in

PCI Anticoagulation with heparin. Wire: BMW Elite 0.014”

Pre-Dilate (Semi-compliant balloon 2.5 x 12 mm to 12 atm)

Stent DES 3.0 x 15 mm to 25 atm

Post-dilation NC Balloon to 30 atm

What’s next? “It’ll be OK”. Use bigger balloon to post-dilate? Call cardiac surgery for 1V CABG Rotational atherectomy Other?

Laser with contrast Half-half contrast, 4 runs, 40 Hz x 40 J/mm2 fluency

Balloon post Laser – 16 atm

Final

Take Home Points Stent Regret Avoidance approach make sure lesion is dilatable and prepped prior to stenting (esp at the VA where calcified lesions are common) – may need atherectomy Laser with contrast is feasible Rotational atherectomy is feasible ?Distal embolization 4. Further research needed