After Deep-Seating… -Case Report- Zheng WU, MD Hongbing YAN, MD Beijing Anzhen Hospital Capital Medical University,Beijing,China.

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Presentation transcript:

After Deep-Seating… -Case Report- Zheng WU, MD Hongbing YAN, MD Beijing Anzhen Hospital Capital Medical University,Beijing,China

Case  Male, 44 yrs old  Paroxymal chest pain for 2 weeks  HBP, Smoke  CAD, UAP

mLAD 50%, LCX(-)

dRCA 90%

6FJR4.0 (deep-seating) AVI2.5×10mm

It seems that something is wrong?!

Endeavor2.5×14mm long segment dissection in p-mRCA

Take one more look

Stop looking! Because…  The patient felt severe chest pain with profuse sweating  BP 70/40mmHg and HR 40bpm  NS infusion 、 dopamin 、 atropin 、 morphine

Endeavor3.5×30mm

Endeavor3.0×30mm,Endeavor3.5×24mm

Final Result

Causes of Secondary Dissection  Catheter (esp deep-seating)  Amplatz 、 EBU 、 XB  Rather rare in Judkins  Guiding wire  Balloon  Stent  Contrast injection

Management  Maintain the hemodynamic stability  Medical therapy  IABP 、 ECMO  CPR  Reperfusion as soon as possible  PCI  CABG  You can STOP procedure when  Patient without/slight symptom  Patient with stable hemodynamics

One case more  Male, 68years  Chest pain for 2hours  Smoke  ECG: II 、 III 、 avF ST↑ mV  STEMI (inferior wall)

mRCA 90%

Zeek aspiration

Cypher 3.5×33mm,Cypher 3.5×33mm

Stents look good,it’s time to end

OH NO!

Stents look good however not everything looks good

Post dilation with NC Sprinter3.5×12mm

7 months later