1. 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

2. 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

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

5. Right coronary angiography Proximal shelve, Distal occlusion

6. BMW Wiring RCA, and manual thrombectomy

7. Successful Distal and Mid BMS deployment

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

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

10. 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 hours

11. Post procedure

12. Relook using 4 French JR 3.5 catheter 72 hours

13. PCI to Proximal RCA Whisper wire, and DES positioing

14. DES inflation and final RCA angiography

15. 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.