Tarek Abou Ghazala, MD, FACC, FSCAI

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Presentation transcript:

Acute Inferior STEMI treated with primary PCI complicated by Proximal Type D dissection Tarek Abou Ghazala, MD, FACC, FSCAI Senior Consultant, Interventional Cardiology Qatar Heart Hospital Hamad Medical Corp Doha, Qatar

46 yr old Bangali man presents to ED with 2 hours of chest pain Patient suffers ventricular fibrillation on arrival and is resuscitated with DC CV. ECG Inferior STEMI Patient started on ASA, Clopidogrel and Heparin and transferred to Heart Hospital for Primary PCI

Left coronary angiography Severe Mid LAD and LCX artery stenoses with L->R collaterals

Right coronary angiography Proximal shelve, Distal occlusion

BMW Wiring RCA, and manual thrombectomy

Successful Distal and Mid BMS deployment

Proximal BMS positioning Proximal BMS positioning. Patient vomits and turns 90 degrees, guide sucked in and stent and wire pulled out.

Proximal Type D RCA dissection and loss of distal flow Proximal Type D RCA dissection and loss of distal flow. Unable to rewire

After removal of all wires, TIMI 2 flow established spontaneously After removal of all wires, TIMI 2 flow established spontaneously. Patient became hypotensive, treated with IV fluids and pressors. CTS consulted. Decision to wait and CABG in 48-72 hours

Post procedure

Relook using 4 French JR 3.5 catheter 72 hours

PCI to Proximal RCA Whisper wire, and DES positioing

DES inflation and final RCA angiography

Waiting for dissection to heal is an option if patient is stable Relook with small caliber diagnostic catheter to confirm healing PCI to dissection with two consultants.