Nightmares in the Cath Lab

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Presentation transcript:

Nightmares in the Cath Lab Alfredo E Rodríguez, MD, PhD, FACC, FSCAI Centro de Estudios en Cardiología Intervencionista (CECI) Buenos Aires, Argentina Washington D.C., February 2010

Alfredo E. Rodriguez, MD, PhD DISCLOSURES Alfredo E. Rodriguez, MD, PhD I have no real or apparent conflicts of interest to report.

CASE 1 M.V. Male 76 yrs old Coronary risk factors:Hypertension, current smoker,dyslipemia, Jun 19, 2008: ACS non STEMI. Chest pain at rest 24 hrs.after stress test. 3 mo before with effort chest pain and also left arm. Current Medication: AAS ACE Inhibitors. EKG:SR,76 x`,no changes. Echocardiography: revealed no regional wall motion abnormality and normal LV systolic function. Then statins,clopidogrel,AAS,LW Heparin,BB,renal protection.

BMS 3.0 x 18 mm.to LAD.

Aug 12,2008: Scheduled PCI to mid LCX with BMS 2.5 x 15 mm IVUS to LAD stent,

Sept ,2008: Cardiac stress testing:

Sept 11,2008: For coronary cath at the hospital Rest Chest pain-VT and VF-Electrical cardioversion

Sept 11,2008: Chest pain-VT and VF-2 Electrical cardioversion during emergency cath . RESTENOSIS-BIFURCATION LESION-TREATMENT?

Sept 11 2008: Chest pain-VT and VF-Electrical cardioversion during emergency cath .PCI with DES to ULM ( Zotarolimus 3.0x24 mm) and DES to prox LCX (Zotarolimus 2.5x24mm).IIB-IIIA platelets inhibitors

T stent at LM bifurcation

KISSING BALLOON

Oct 17 2008 scheduled control cath LM. Without symptoms.

Dec 10,2008. chest pain class II-III. ISR Ostium LM and LCX Dec 10,2008.chest pain class II-III. ISR Ostium LM and LCX .VT and VF – (E .Cardioversion ).IABP. PCI AGAIN?-PCI THEN CABG?-CABG?

10 dec 2008 ISR Ostium LM and LCX( BMS 3 10 dec 2008 ISR Ostium LM and LCX( BMS 3.5x13 mm) and POBA to ostium LCX .VT and VF – (E.Cardioversion before procedure).IABP. Sent to CABG.SG to LCX.MA To LAD.

Feb 27, 2009 – Post CABG (SG to LCX and MA to LAD)

Feb 27, 2009 – Post CABG (SG to LCX and MA to LAD)

Feb 27, 2009 – Post CABG (SG to LCX and MA to LAD) DES (Rapamycin coated stent 3.5 x 18 mm) to LM. DES (rapamycin coated stent 2.75 x 33 mm) to LCX.

FINAL VIEW

CASE 2 M.B. Female 78 yrs old Coronary risk factors: Hypertension, high cholesterol, diabetes Current Medication AAS, Beta Blockers, Telmisartan, Diuretics, Insulin In the last two months the patient developed progressive angina to class IV. Thalium scintigraphy (january 20th, 2010) with apical and postero inferior ischemia. She was schedulled for angiography (february 10th, 2010). That morning, in-hospital, she developed chest pain at rest and acute pulmonary edema, requiring intubation and hemodinamic support. Ekg with st elevation in inferior leads and st depresion in anterolateral leads.

Previous Angiography Intra PCI

Guide catheter FL 3.0 7 Fr. 2 x wires Previous Balloon 2.0 x 15 mm Ostium LM DES 3 SES (Microport) 3.00 x 13 mm Distal de LM ostium + LAD ZES (Endeavor) 2.5 x 24 mm, Distal LM + ostium LCX BMS (Tsunami gold) 2.5 x 15 mm

Post- PCI At 48HS