Session Date: 28th Nov’14 Session Time: 14:30 – 16:00 PRIMARY ANGIOPLASTY IN AN ABNORMAL ORIGIN RCA FROM NON-CORONARY CUSP USING OVERLAPPING BIOABSORBABLE SCAFFOLDS IN AN OCTAGENERIAN PATIENT Dr Arindam Pande, Dr Rabin Chakraborty APOLLO GLENEAGLES HOSPITAL, KOLKATA, INDIA Session Date: 28th Nov’14 Session Time: 14:30 – 16:00

CLINICAL BACKGROUND 86 years male Hypertensive, Non-diabetic, Non-Smoker Presented with ongoing chest pain since last 18 hours ECG shows acute IWMI Sinus rhythm, SBP of 90 mm Hg Urgently shifted to cathlab after initial loading of antiplatelets

CAG: Distal left-main minor stenosis & OM 1 significant stenosis

CAG reveals abnormal origin of RCA from Non-coronary cusp

CAG reveals abnormal origin of RCA from Non-coronary cusp

RCA from Non-coronary cusp with thrombotic total occlusion at mid part (RCA engaged with AL 0.75)

LESION CROSSED WITH BMW ELITE WIRE

LESION CROSSED WITH BMW ELITE WIRE

Serial balloon dilatation

POST BALLOON DILATATION

Distal stent placement: 3×28 mm ABSORB

Distal stent deployment

Distal stent deployment

Post distal stent deployment

Proximal stent placement: 3.5×18 mm ABSORB

Proximal stent placement: 3.5×18 mm ABSORB

Proximal stent placement: 3.5×18 mm ABSORB

Proximal stent placement: 3.5×18 mm ABSORB

POST STENT

Stent boost showing perfect overlapping of the platinum markers

Serial post dilatation with non-compliant balloons

FINAL RESULT

FINAL RESULT

LEARNING POINTS Selecting appropriate hardware is of foremost importance to reduce procedure time in emergency conditions such as primary PCI -- in our case we quickly shifted to AL 0.75 after initial attempts with other catheters. Bioabsorbable scaffolds can also be used in primary PCI. Thrombosuction can be avoided in patients of delayed presentation AMI Principle of overlapping BVS is to keep dot on dot (5 mm overlapping is not essential).