1. PCI in patients with cardiogenic shock associated with acute occlusion of the left main coronary artery

2. Patient urgently transferred to the catheterization laboratory
Current presentation
57 year-old man, chest pain > 2 hours and palpitation
Risk factors
Arterial hypertension
Diabetes mellitus type 2
Active smoker
Instrumental data
BP – 70/40 mmHg
ECG - ST depression in leads II, III, aVF, V2 – V6
Transthoracic ECHO - hypokinetic anterior wall , ejection fraction 30%
Diagnosis
NSTEMI, Cardiogenic shock, Killip IV.
Patient urgently transferred to the catheterization laboratory
Case 1

3. Angiographic data Retrograde filling of the left arteries
Right femoral artery approach
6 Fr sheath
5 Fr diagnostic catheter
Total occlusion of the left main
LCx
D 1
Distal LAD
Anteroposterior caudal projection
Anteroposterior cranial projection

4. Procedure XB 3.5 guiding catheter
Runthrough NS floppy guidewire (hydrophilic) to the LAD
Balloon predilatation with semi-compliante balloon catheter × 10 mm (8 atm)

5. Procedure (cont.) Final result after stent implantation
Stenting followed by the final kissing balloon postdilatation
3.5 × 18 mm BMS
LM - LAD
After balloon predilatation
After balloon predilatation conducted second Runthrough NS floppy guidewire to the LCx
Final result after stent implantation
and postdilatation with 4.0 × 10 mm
NC balloon

6. Follow up
6 months later

7. Comorbidities and bad habits
Current presentation
64 year-old man, chest pain > 1 hours and palpitation
Risk factors
Arterial hypertension
Active smoker
Instrumental data
BP – 80/30 mmHg
ECG - ST depression in leads V4 – V6
Transthoracic ECHO - akinesia anterior wall and the apex, ejection fraction 33%
Comorbidities and bad habits
Aneurysm of the ascending aorta, d = 4.8 cm
Chronic obstructive pulmonary disease
Diagnosis
NSTEMI, Cardiogenic shock, Killip IV.
Patient urgently transferred to the
catheterization laboratory
Case 2

8. Angiographic data Right radial artery approach 6 Fr sheath
5 Fr diagnostic catheters
LAD
Total occlusion of the left main
Aneurysmal right coronary artery
and retrograde filling of the LAD
Anteroposterior caudal projection
RAO caudal projection

9. Angiographic data

10. Procedure XB 3.5 guiding catheter
Runthrough NS floppy guidewire (hydrophilic) to the Ramus
Multiple balloon predilatation with semi- and non-compliante balloon catheters 2.0 × 15 mm (8 atm) and 2.25 × 15 mm (14 atm) respectively

11. Procedure (cont.)
After balloon predilatation conducted second Runthrough NS floppy guidewire to the LAD
LCx
Culprit lesion
Ramus
LAD
Anteroposterior cranial projection

12. Procedure (cont.)
Stenting followed by the final kissing balloon postdilatation
Тhe patient has been stabilized and two weeks later was operated CABG
BMS 3.0 × 15 mm
LM-Ramus
Final result after stent implantation

13. Final result