global advisory board meeting case presentation georgios i. papaioannou, md athens medical center...
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![Page 1: Global Advisory Board Meeting Case Presentation Georgios I. Papaioannou, MD Athens Medical Center Cardiac Catheterization Laboratory](https://reader035.vdocuments.mx/reader035/viewer/2022062500/5697bfd11a28abf838cab0df/html5/thumbnails/1.jpg)
Global Advisory Board Meeting
Case Presentation
Georgios I. Papaioannou, MD
Athens Medical Center
Cardiac Catheterization Laboratory
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Global Advisory Board Meeting
Clinical History• 87 year old male with prior hx of CAD s/p
CABGx3 in 2001 (SVGLAD, SVGOM, SVGRCA), s/p Permanent Pacer in 2004, had 2 recent admissions for UA /Biomarker positive ACS stabilized with Rx – in good physical shape
• CRF: DM, HTN, Dyslipidemia, CRF (Crea=1.9)• Echo with EF=45%, anterior+inferior
hypokinesis, moderate MR – no stress test performed – referred for angiography
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Global Advisory Board Meeting
Angiogram 1 mo ago–Native LCA
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Global Advisory Board Meeting
Native RCA
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Global Advisory Board Meeting
SVGOM
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Global Advisory Board Meeting
SVGRCA
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Global Advisory Board Meeting
SVGLAD
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Global Advisory Board Meeting
SVGLAD
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Global Advisory Board Meeting
Angiogram results• Severe 3VD (LAD 70% prox and diffuse 70-80% after
SVG anastomosis, 100% CX and severe calcified prox RCA 80% and 90% at origin of PLV)
• 60% SVG LAD eccentric stenosis, 100% SVGRCA, Mild disease of SVGOM at its origin
• Any intervention postponed for 2nd time after appropriate planning and checking the response to given dye (110 ml)
• Crea at day 52.3 returned to 1.8 after 2 weeks and stabilized at that value – returned for PCI of RCA+LAD
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Global Advisory Board Meeting
PCIRCA
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Global Advisory Board Meeting
PCIRCA (PLV)
Endeavor Resolute 2.75 x 18
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Global Advisory Board Meeting
PCIRCA
Endeavor Sprint 3.5x18
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Global Advisory Board Meeting
PCIRCA final
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Global Advisory Board Meeting
PCILAD via SVG
Endeavor Resolute 2.5x12 + 2.5x14
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Global Advisory Board Meeting
PCI of SVGLAD
Endeavor Resolute 2.75x12
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Global Advisory Board Meeting
PCILAD Final
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Global Advisory Board Meeting
Case Characteristics- Conclusions
• Vessel tortuousity + severe calcification (RCA) – necessity of a deliverable stent
• Vessel size + SVG graft – necessity of reduced probability of ISR
• Increased age - ? Reduced duration of dual antiplatelet Rx