Shanghai Jiaotong University

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Presentation transcript:

Shanghai Jiaotong University PCI for a Patient with Multivessel Disease and Renal Transplantation --- Case Report Zhang Qi, MD RuiJin Hospital Shanghai Jiaotong University School of Medicine

Case Introduction Male, 70y OMI (ant), SAP, HBP Previous MI : Jan, 2000 Other history : renal transplantation due to 10ys of chronic renal failure in 2007 EKG: Q wave in anterior leads (V1-4) UCG: LVEF 0.41 Serum Cr 108umol/L (1.22mg/dl), estimated Ccr=58.6

CAG Results 2010-1-28

Interpretation and Strategy Multivessel disease with compromised LV function CABG PCI Renal Status: Cr 108umol/L, three years after renal transplantation Medication: still on anti- rejection regimen (predinisone and CTX) LAD: Succeed LAD: Fail Partial Revascularization w/ PCI & medication Medication only

Renal Function Consideration Estimated maximal contrast consumption 73.5kg in body weight, with baseline Cr 108umol/L MRCD=301ml Hydration strategy Iso-osmolar contrast

Finecross Microcatheter + Miracle 3.0 Double Wires: Miracle 3.0/4.5 PCI for LAD 7F EBU 3.75 G.C. Finecross Microcatheter + Miracle 3.0 Double Wires: Miracle 3.0/4.5 “4.5 in microcatheter”

Change to Pilot 150 in microcatheter, Micracle 3.0 into diagonal area PCI Change to Pilot 150 in microcatheter, Micracle 3.0 into diagonal area Pilot 150 failed to reach the LAD middle true lumen, but Micracle 3.0 placed into distal diagonal branch

PCI Strategy changed to predilate the diagonal first with a 1.25x15mm balloon

PCI Re-efforts in LAD, with Conquest-pro wire True lumen placement, proved by multiple projections

PCI Predilate LAD with 1.5x15mm Apex-Push Balloon True lumen position of Conquest wire re-confirmed

PCI Predilate with 2.0x20mm Balloon After predilatation, and stents were ready

PCI 3.0x36mm SES 16atm 3.5x33mm SES 16atm

Final Results of LAD PCI Post-dilate with 3.5x33mm stent balloon @ 18atm Final Results

Temporary Conclusions 2hours, 400ml contrast (iso-) consumption Both doctors and patient are tired Elective PCI for RCA and LCX was planned Hydration strategy was applied before PCI and continued for 12hours after PCI, with 1ml/kg/h NS intravenously infusion

Elective PCI for RCA & LCX 2010-2-23

30 minutes and 100ml contrast consumption ! PCI for RCA & LCX 3.0x36mm SES 2.75x23mm SES 30 minutes and 100ml contrast consumption !

Renal Function Monitoring Cr. (umol/L) BUN (mmol/L) 2010-1-26 108.0 9.1 2010-1-29 113.0 6.8 2010-2-9 106.0 7.2 2010-2-20 102.0 8.1 2010-2-25 97.0 6.7

Take Home Messages In CAD patients with co-morbidities, including severe noncardiac conditions (renal, lung), CABG may be contra-indicated. PCI may leave to be the only choice to improve survival status. Advances in PCI for CTO lesions: equipments (wires, microcatheter,etc) , techniques (retrograde, multiple wires, etc.)

Take Home Messages In some circumstance in CTO PCI, wire is easy to reach the branch vessel distal to occlusion, and predilate the branch distal to occlusion may help to reach the main vessel by another wire.

Thanks