1. 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’ Session Time: 14:30 – 16:00

2. 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

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

4. CAG reveals abnormal origin of RCA from Non-coronary cusp

5. CAG reveals abnormal origin of RCA from Non-coronary cusp

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

7. LESION CROSSED WITH BMW ELITE WIRE

8. LESION CROSSED WITH BMW ELITE WIRE

9. Serial balloon dilatation

10. POST BALLOON DILATATION

11. Distal stent placement: 3×28 mm ABSORB

12. Distal stent deployment

13. Distal stent deployment

14. Post distal stent deployment

15. Proximal stent placement: 3.5×18 mm ABSORB

16. Proximal stent placement: 3.5×18 mm ABSORB

17. Proximal stent placement: 3.5×18 mm ABSORB

18. Proximal stent placement: 3.5×18 mm ABSORB

19. POST STENT

20. Stent boost showing perfect overlapping of the platinum markers

21. Serial post dilatation with non-compliant balloons

22. FINAL RESULT

23. FINAL RESULT

24. 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).