Upload File

call for cases staged pci in a patient with multivessel coronary disease disqualified from cabg....

  • Home
  • Documents
  • Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof
12
Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof Milewski American Heart of Poland, Ustron, Poland & CCU, Upper-Silesian Heart Center Silesian Medical School Katowice, Poland

Upload: charity-hampton

Post on 11-Jan-2016

216 views

Category:

Documents


0 download

Report

Tags:

TRANSCRIPT

Page 1: Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof

Call for CASES

Staged PCI in a patient with multivessel coronary disease disqualified from CABG.

Pawel Buszman, MD, FESC, FSCAIMarcin Debinski, MDKrzysztof Milewski

American Heart of Poland, Ustron, Poland&

CCU, Upper-Silesian Heart CenterSilesian Medical School

Katowice, Poland

Staged PCI in a patient with multivessel coronary disease disqualified from CABG.

Pawel Buszman, MD, FESC, FSCAIMarcin Debinski, MDKrzysztof Milewski

American Heart of Poland, Ustron, Poland&

CCU, Upper-Silesian Heart CenterSilesian Medical School

Katowice, Poland

Page 2: Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof

Introduction• PCI and CABG offer similar long term results (in respect to MI PCI and CABG offer similar long term results (in respect to MI

and death) in patients with moderately advanced coronary and death) in patients with moderately advanced coronary artery disease (CAD).artery disease (CAD).

• There are very few information on effectiveness of PCI in There are very few information on effectiveness of PCI in patients with diffuse CAD and high risk of surgical patients with diffuse CAD and high risk of surgical intervention.intervention.

• Technological progress in interventional cardiology together Technological progress in interventional cardiology together with advances in pharmacology should result in better with advances in pharmacology should result in better outcome in patients with end stage coronary artery disease. outcome in patients with end stage coronary artery disease.

• PCI and CABG offer similar long term results (in respect to MI PCI and CABG offer similar long term results (in respect to MI and death) in patients with moderately advanced coronary and death) in patients with moderately advanced coronary artery disease (CAD).artery disease (CAD).

• There are very few information on effectiveness of PCI in There are very few information on effectiveness of PCI in patients with diffuse CAD and high risk of surgical patients with diffuse CAD and high risk of surgical intervention.intervention.

• Technological progress in interventional cardiology together Technological progress in interventional cardiology together with advances in pharmacology should result in better with advances in pharmacology should result in better outcome in patients with end stage coronary artery disease. outcome in patients with end stage coronary artery disease.

Page 3: Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof

Description of the problem

• Male, 76 years old

• Unstable Angina, class CCS IV

• Medical history: 2xMI (1994-nonQ anterior, 2003-inferior wall)

• CAD Risk factors: HA, family history, former smoker

• LVEF 40%

• EUROSCORE 13 points:

– age 4 pt

– unstable angina after AMI 2 pt

– peripherial atherosclerosis 2 pt– paroxysmal FA 3 pt– chronic obstructive

pulmonary disease 1 pt. – respiratory insufficiency 1 pt.

Page 4: Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof

Description of the problemCoronary arteriography:

RCA: 60% stenosis in prox. RCA, 99% narrowing in med segment

LCA:

LM-diam. ca 3.5-4 mm, length 15mm,

LAD-30% prox.lesion; critical, long, calcified, tortous lesions in med and distal LAD,

Cx-90% type A lesion in prox, 99% type B2 lesion in distal segment.

RCA LAO60 LCA: RAO 30 LCA: LAO60/cran25

Page 5: Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof

Intended strategy

• Multiple, stage PCI with continous control of previously dilated vessels/segments.

• Use of bare metal stents to minimize costs of procedures.

• Carefull evaluation of contrast volume used for each procedure and renal function before/after eache stage.

• Concomitant pharmacological treatment:ASA 150mg o.d., clopidogrel 75mg o.d.,ACEI, selective beta-blocker, statins,

Page 6: Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof

First stage

Right coronary artery (RCA) in LAO 60, before and after PTCA.

Aug’2003: Predilatation of critical lesion in med RCA (balloon 3.0x20mm) and stenting of prox/med. segment (stent Chopin, Balton,

3.5x34mm, 18 atm). No complications. Hospitalization 6 days.

Page 7: Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof

Second Stage

Fig 1. Left coronary artery (LCA) in LAO 60, before and after PCI to Cx.

Sept’2003: RCA: non-significant narrowings in med segments. PCI to Cx: POBA of distal lesion and predilatation and stenting of

prox lesion (Chopin 3.0x8mm, 18 atm.) No complications. Hospitalization 3 days.

Page 8: Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof

Third Stage

Dec’2003: RCA: patent and large vessel, non-significant narrowing in med segments. Cx: restenosis in distal segment (75%).

PCI to LAD: predilatation (balloon 1.5x20 & 2.0x20mm) and stenting of med/distal LAD (Multilink Zeta, 18 atm.). VF during stent implantation, successfully defibrillated within 15 s (1x300W). No further resuscitation or intubation required.PCI to Cx: POBA of distal restenotic lesion (balloon 2.5x20mm), residual stenosis<30%.

Lab tests: Troponin I 1.04ng/ml; CK 337 U/l, CKMB 31 U/L.

Hospitalization: 4 days.

Page 9: Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof

Third Stage

Fig 1. Left coronary artery (LCA) in LAO 60, before and after PCI.

Page 10: Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof

Fourth Stage

LCA: RAO 30RCA: LAO 60 LCA: LAO20/cran25

March’2004: A control angio revealed patent coronary arteries without significant stenosis.

Page 11: Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof

Follow-up

9 months after the first stage we noticed:• No significant stenosis in coronary arteries• LVEF improvement (55%)• Decrease of angina symptoms (CCS I)• Improvement in quality of live, NYHA class II• No further intervention requiered.

Further intensive pharmacological treatement:statins

beta-blockerACEIASA

Page 12: Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof

Conclusions

• Stage PCI is a rational alternative to CABG in patients with advanced coronary artery disease and high risk of perioperative complications.

• In patients undergoing POBA or bare metal stent implantation a routine follow-up angio should be considered.

• Stage PCI offers opportunity to review previously dilated/stented coronary segments. It may limit obligatory use of DES.


Physician CONNECTION...Michael Mersol-Barg MD Imad Modawi MD Robert Molnar MD Susan Mosier-LaClair MD Nkechi Onwuzurike MD Ronny Otero MD Damayanthi Pandrangi MD David Parrish MD Sergio

© 2009 Alejandro Gerardo Pietrekufdcimages.uflib.ufl.edu/UF/E0/02/41/79/00001/pietrek_a.pdf(Offerman et al. 1995, Turner 1996, Laurance et al. 2002, Debinski and Holt 2003, Parker

Editorial Board...HUMPHREY, MD JASON EMER, MD ADAM SCHAFFNER, MD HENRY SPINELLI, MD GRANT STEVENS, MD ANDREW JACONO, MD MICHAEL KAMINER, MD Editorial …

PERMA PURE · md-050+wl±fie md-050-12 md-050-24 md-050-48 md-050-72 -20 õ -30 -40 10 -20 -25 md-070-12 md-070-48 md-070-24 md-070-72 md-070-96 md-070-144

Species Traits as Filters of Climate-Induced Range Expansion DIANE DEBINSKI JEREMY KERR AND MAXIM LARRIVÉE IOWA STATE UNIVERSITY, UNIVERSITY OF OTTAWA,

M Krishnamoorthy MD, S Krishnamoorthy MD, J Beard MD, FACP ... · M Krishnamoorthy MD, S Krishnamoorthy MD, J Beard MD, FACP, J Bolyard MD, FACP, A Chakka MD, FACP, J. Sutton MD,

American Thoracic Society · Farrukh Abbas, MD Ahmed Abdelbasit, MD Dionne Adair, MD Muhammad Ali, MD Nancy Allen, MD Dagny Anderson, MD Juan Barron, MD Sarah Bauer, MD Moeezullah

Les élèves de sciences 10 découvrent la différence · PDF fileLes élèves du cours biologie 20 ont visité le verger conservatoire de Muttart. ... Michael Debinski, ... Aaron

OriginalInvestigation PrevalenceofCerebralAmyloidPathology … · MarkForrestGordon,MD;TimoGrimmer,MD,PhD; HaraldHampel,MD,PhD;LucreziaHausner,MD,

 · 2021. 1. 3. · mohammad mahabub md. khurshid alam zulfiqar hasan mohammad azizul haque uggal mohammed rafiqul islam md. chand alam alauddin akand md. md. md. md. md. md. md

Volker Klauss, MD Patrick W. Serruys, Simon Wandel, Pawel Buszman,

Novel paclitaxel coated balloon - dr Piotr Buszman

RG 326 Atomic Energy Commission Manhattan … 326 Atomic Energy...md-070 md-072 md-097.31 mp092 md-121.2 md-121.4 md-121.6 md-721.6 md-132.2 md- 140 md- 1 40 md- 1 40 md- 1 50 md-

Sílvia Monteiro MD, Inês Casal MD, Ana Figueiredo MD ... · Sílvia Monteiro MD, Inês Casal MD, Ana Figueiredo MD, Carolina Vale MD, Maria João Furtado MD, Angelina Meireles MD

€¦ · md. hasan md. md. md. md. md. masudur rahman ismail hossain tawfik ahmed rashedul islam shahadath hosen mst. nadiya sultana mst. amina khatun khondker md. monirul islam md

Burcu Oktay MD , Sadık Ardıç MD, Hikmet Firat MD, Erdem Akbal MD, Ramazan Akdemir MD

2wl.wum.edu.pl · MD PhD, Marek Janiak MD, Marek Paśnicki MD, Paweł Zatorski MD PhD, Jan Pluta MD, Ewa Puchalska-Kowalczyk MD, Piotr Andrzejak MD, Anna Gruźlewska MD, Mateusz Klukowski

M. Vokrojova MD, M. Vokrojova MD, D. Sivekova MD, L. Wagnerova MD D. Sivekova MD, L. Wagnerova MD Prof. P. Kuchynka MD, PhD Prof. P. Kuchynka MD, PhD The

Yonca A . Akova , MD, Mehmet Borazan, MD; Aylin Karalezli, MD; Cem Kucukerdonmez, MD ; Ahmet Akman , MD; Sevsen Kulaksizoglu, MD

Sílvia Monteiro MD, Inês Casal MD, Luís Miguel Neves MD ......Sílvia Monteiro MD, Inês Casal MD, Luís Miguel Neves MD, Mafalda Macedo MD, Maria João Furtado MD, Angelina Meireles

Don Davis, MD, Peter Ness, MD, Surekha Maddula, MD, Liliana Werner, MD, PhD, Nick Mamalis, MD

Multivessel PCI procedure complicated with fracture of the wire Marcin D ę binski, MD Head: Pawel E. Buszman, MD, FACC University Hospital of Silesia,

One stage coronary and peripheral intervention Pawel Buszman, MD, American Heart of Poland, Ustron Silesian Medical School, Katowice

Call for CASES Silesian Medical School, Katowice, Poland Percutenous Controlled Reperfusion For STEMI P iotr P. Buszman

PAC Members · Edwin Hissa MD David Hochschild MD W Hodge FACS, MD Scott Hodges DO Rudolf Hoellrich MD Steven Hoer MD Eric Hoffman MD Mark Hollmann MD G Holloway MD Timothy Holt MD

 · timothy j. marten, md mohsen naraghi. md pietro palma, md norman j. pastorek md stephen w. perkins, md volney pitombo, md brunno ristow md enrico robotti, md rod j. rohrich, md

Daisuke Aizawa,MD Kazutaka Kamiya,MD Tetsuya Ikeda,MD Kimiya Shimizu,MD

Emory Department of Anesthesiology...Meka, MD Max Schubert, MD Tyler Smith, MD Zia Siddiqui, MD Annie Song, MD Eric Yao, MD Sai Alla, MD Alex Balmaceda, MD Jay Bryant, MD Cristen Cain,

MP T.INTAN MD SELAMA MD T.MALIM MD B.GAJAH MD … · mp t.intan md selama md t.malim md b.gajah md p.tengah mp taiping mp manjung md kampar suk perak mb ipoh md kerian md gerik md

MULTIDISCIPLINARY APPROACH Program.pdf · Fadi Nasr, MD Members Hanane Yassine, MD Mohamad Haidar, MD Naji Amro, MD Rita Murr, MD Walid Moukadem, MD Hazem Assi, MD Jad Wakim, MD Joseph

Azmi HAMZAOGLU, MD Cagatay OZTURK, MD Ahmet ALANAY, MD Mehmet TEZER, MD Selhan KARADERELER, MD

METREL MD 9040 & MD 9050 … · METREL MD 9040 & MD 9050 . MD 9040. TRMS Industrial Digital Multimeter . MD 9050 TRMS. Heavy Duty Industrial Digital Multimeter . MD 9040 & MD 9050

MD BOL IV A MD µ0 MD

Katsuya Yamazoe, MD, Takefumi Yamaguchi, MD, Kazuki Hotta, MD, Yoshiyuki Satake, MD, Kenji Konomi, MD, Seika Den, MD, Jun Shimazaki, MD Presented by: Abdulrahman

Document5 - WordPress.com · md razib hossain ismail hossain md. abu hasan hero md. . syed anwar md md. salim md habibur rahman md.shajahan miah md. selim mondal md. siddikur rahman