![Page 1: Primary AngioplastyPrimary Angioplasty involving Left Mainsummitmd.com/pdf/pdf/1757_Dr.Singh-TCTAP-2.pdf · Primary AngioplastyPrimary Angioplasty involving Left Main Dr.Shailendra](https://reader031.vdocuments.mx/reader031/viewer/2022020206/5e1724ffe06fcf032d3ad2e9/html5/thumbnails/1.jpg)
Primary AngioplastyPrimary AngioplastyPrimary Angioplasty Primary Angioplasty involving Left Maininvolving Left Main
Dr.Shailendra Singh MD.,DMDr.Shailendra Singh MD.,DMDr.Shailendra Singh MD.,DMDr.Shailendra Singh MD.,DMKamineni HospitalKamineni HospitalHyderabad, IndiaHyderabad, India
![Page 2: Primary AngioplastyPrimary Angioplasty involving Left Mainsummitmd.com/pdf/pdf/1757_Dr.Singh-TCTAP-2.pdf · Primary AngioplastyPrimary Angioplasty involving Left Main Dr.Shailendra](https://reader031.vdocuments.mx/reader031/viewer/2022020206/5e1724ffe06fcf032d3ad2e9/html5/thumbnails/2.jpg)
C Hi tC Hi tCase HistoryCase History
72 yr old/male72 yr old/maleHTN Di b tHTN Di b tHTN, DiabetesHTN, DiabetesAcute Chest pain 4 hours duration with BP Acute Chest pain 4 hours duration with BP 80/6080/6080/60.80/60.ECG Shows ST elevation inferio letral Lead.ECG Shows ST elevation inferio letral Lead.
![Page 3: Primary AngioplastyPrimary Angioplasty involving Left Mainsummitmd.com/pdf/pdf/1757_Dr.Singh-TCTAP-2.pdf · Primary AngioplastyPrimary Angioplasty involving Left Main Dr.Shailendra](https://reader031.vdocuments.mx/reader031/viewer/2022020206/5e1724ffe06fcf032d3ad2e9/html5/thumbnails/3.jpg)
Ch llCh llChallengesChallenges
Patient presented in Cardiogenic shock Patient presented in Cardiogenic shock with acute inferioletral MI.with acute inferioletral MI.Involving Left Main LesionInvolving Left Main LesionInvolving Left Main Lesion.Involving Left Main Lesion.
![Page 4: Primary AngioplastyPrimary Angioplasty involving Left Mainsummitmd.com/pdf/pdf/1757_Dr.Singh-TCTAP-2.pdf · Primary AngioplastyPrimary Angioplasty involving Left Main Dr.Shailendra](https://reader031.vdocuments.mx/reader031/viewer/2022020206/5e1724ffe06fcf032d3ad2e9/html5/thumbnails/4.jpg)
InterventionalInterventionalInterventional Interventional ManagementManagement
EBU 3.5, 7 FEBU 3.5, 7 FCougar, Whisper MS guide wireCougar, Whisper MS guide wireVoyager NC & Maverick BDCVoyager NC & Maverick BDCy gy gEnd. Res. 2.5x18,3.0x18,3.5x18 mm End. Res. 2.5x18,3.0x18,3.5x18 mm
![Page 5: Primary AngioplastyPrimary Angioplasty involving Left Mainsummitmd.com/pdf/pdf/1757_Dr.Singh-TCTAP-2.pdf · Primary AngioplastyPrimary Angioplasty involving Left Main Dr.Shailendra](https://reader031.vdocuments.mx/reader031/viewer/2022020206/5e1724ffe06fcf032d3ad2e9/html5/thumbnails/5.jpg)
I t ti l P dI t ti l P dInterventional ProcedureInterventional Procedure
Non dominant RCA Ostial LAD & Ostial LCX tight lesion
![Page 6: Primary AngioplastyPrimary Angioplasty involving Left Mainsummitmd.com/pdf/pdf/1757_Dr.Singh-TCTAP-2.pdf · Primary AngioplastyPrimary Angioplasty involving Left Main Dr.Shailendra](https://reader031.vdocuments.mx/reader031/viewer/2022020206/5e1724ffe06fcf032d3ad2e9/html5/thumbnails/6.jpg)
I t ti l P dI t ti l P dInterventional ProcedureInterventional Procedure
Left main dissected plaque GW in LAD & LCX
![Page 7: Primary AngioplastyPrimary Angioplasty involving Left Mainsummitmd.com/pdf/pdf/1757_Dr.Singh-TCTAP-2.pdf · Primary AngioplastyPrimary Angioplasty involving Left Main Dr.Shailendra](https://reader031.vdocuments.mx/reader031/viewer/2022020206/5e1724ffe06fcf032d3ad2e9/html5/thumbnails/7.jpg)
C tiC tiContinue…Continue…
Stent placement in LCX Stent Inflation
![Page 8: Primary AngioplastyPrimary Angioplasty involving Left Mainsummitmd.com/pdf/pdf/1757_Dr.Singh-TCTAP-2.pdf · Primary AngioplastyPrimary Angioplasty involving Left Main Dr.Shailendra](https://reader031.vdocuments.mx/reader031/viewer/2022020206/5e1724ffe06fcf032d3ad2e9/html5/thumbnails/8.jpg)
C tiC tiContinue…Continue…
Post LCX stent Angio 2nd lesion in LCX
![Page 9: Primary AngioplastyPrimary Angioplasty involving Left Mainsummitmd.com/pdf/pdf/1757_Dr.Singh-TCTAP-2.pdf · Primary AngioplastyPrimary Angioplasty involving Left Main Dr.Shailendra](https://reader031.vdocuments.mx/reader031/viewer/2022020206/5e1724ffe06fcf032d3ad2e9/html5/thumbnails/9.jpg)
C tiC tiContinue…Continue…
2ND Stent in LCX Stent covering Ostium of LCX
![Page 10: Primary AngioplastyPrimary Angioplasty involving Left Mainsummitmd.com/pdf/pdf/1757_Dr.Singh-TCTAP-2.pdf · Primary AngioplastyPrimary Angioplasty involving Left Main Dr.Shailendra](https://reader031.vdocuments.mx/reader031/viewer/2022020206/5e1724ffe06fcf032d3ad2e9/html5/thumbnails/10.jpg)
C tiC tiContinue…Continue…
Balloon crushing stent in LMCA & LCX Ostium
Stent From Covering LMCA Ostiumto Proximal LAD
![Page 11: Primary AngioplastyPrimary Angioplasty involving Left Mainsummitmd.com/pdf/pdf/1757_Dr.Singh-TCTAP-2.pdf · Primary AngioplastyPrimary Angioplasty involving Left Main Dr.Shailendra](https://reader031.vdocuments.mx/reader031/viewer/2022020206/5e1724ffe06fcf032d3ad2e9/html5/thumbnails/11.jpg)
C tiC tiContinue…Continue…
Stent From Covering LMCA Ostiumto Proximal LAD
Stent Inflation
![Page 12: Primary AngioplastyPrimary Angioplasty involving Left Mainsummitmd.com/pdf/pdf/1757_Dr.Singh-TCTAP-2.pdf · Primary AngioplastyPrimary Angioplasty involving Left Main Dr.Shailendra](https://reader031.vdocuments.mx/reader031/viewer/2022020206/5e1724ffe06fcf032d3ad2e9/html5/thumbnails/12.jpg)
C tiC tiContinue…Continue…
After Recrossing the GW kissing balloon dilatation
Final Result
![Page 13: Primary AngioplastyPrimary Angioplasty involving Left Mainsummitmd.com/pdf/pdf/1757_Dr.Singh-TCTAP-2.pdf · Primary AngioplastyPrimary Angioplasty involving Left Main Dr.Shailendra](https://reader031.vdocuments.mx/reader031/viewer/2022020206/5e1724ffe06fcf032d3ad2e9/html5/thumbnails/13.jpg)
T k HT k HTake Home messageTake Home message
Left Main bifurcation Stenting in the setting Left Main bifurcation Stenting in the setting f AMI & C di i h k b df AMI & C di i h k b dof AMI & Cardiogenic shock can be done of AMI & Cardiogenic shock can be done
with reasonable safety by minicrush with reasonable safety by minicrush t h it h itechnique.technique.Patient Follow up next day morning was Patient Follow up next day morning was taken out & patent reasonably well & taken out & patent reasonably well & discharged on day 5.discharged on day 5.6 Month follow up TMT Negative & patent 6 Month follow up TMT Negative & patent asymptamatic.asymptamatic.y py p