pci for complex multiple vessel lesion after cabg surgerysummitmd.com/pdf/pdf/1886_after...

PCI for Complex Multiple Vessel lesion after CABG Surgerylesion after CABG Surgery

Liu,XueboSh n h i E st H spit l T n ji Univ rsitShanghai East Hospital, Tongji University

Shanghai East HospitalShanghai East Hospital

HistoryHistory

Male，79- year- oldUnderwent CABG in other hospital 3 year ago Underwent CABG in other hospital 3 year ago due to severe chest painCABG modality：LIMA-LAD， OA-SV-LCX，OA-SV-yRCA， D2-SV-OMNO coronary risk factors except for DMRecurrent chest pain again in recent timeCoronary CTA：SV-LCX occluded ，SV-RCAoccluded，RCA severe narrowing


Left Coronary Angiogramy g g

Distal LM 90% stenosisLCX 95% stenosis at ostium TIMI 3 flow


LCX 95% stenosis at ostium，TIMI 3 flowtotal occlusion of large OM，retrograde collateral flow fromsequential SV (from D2)

Left Coronary Angiogramy g g

LAD90% stenosis at ostium90% stenosis at ostiumTotal occlusion from mid LAD90%stenosis at big D2 branch，connecting with OM through SVg

LCXnearly right angle with y g gLM


Right Coronary Angiogramg y g g

• Diffuse lesion with 60% stenosis and hazy appearance at mid-RCA 80-90% stenosis at distal PLA with TIMI 3 flow


mid-RCA, 80-90% stenosis at distal PLA with TIMI 3 flow

LIMA angiograma g og a

• LIMA LAD is patent no • LIMA-LAD is patent，no

narrowing at

t ti itanastomostic site

• SV-RCA、SV-LCX were

invisible


Index PCI

6F EBU 3.5 Guiding Catheter0 014” R th h GW i t D2 PT50 GW i t LCX diffi lt


0.014” Runthrough GW into D2；PT50 GW into LCX-----difficult2.5*20mm Sprinter Balloon predilate LAD-D2 & LMCA2.0*15mm Sprinter Balloon predilate LCX

Index PCI

2.5*18mm DES deployed at prox D2 to LAD

Shanghai East HospitalShanghai East Hospital3.5*18mm DES at LM-LAD, overlap the first stent and Cross-over LCX

Index PCI

• no LCX flow and severe

chest pain with decreasing

heart rate

• Crosswire NT rewiring LCX

• Tirofaban was administered Tirofaban was administered

intravenously

immediately after stenting


immediately after stenting

Index PCI

• 2.0*15mm balloon

t dil t j il d post-dilate jailed

LCX ostium


Index PCI

Shanghai East HospitalShanghai East Hospitalfinal result

1-M FU after Index PCI1 M FU after Index PCI

• Mild chest compression after procedure and

received Tirofaban intravenously for 24 hours

• Medical treatment regularly after first day Medical treatment regularly after first day

• No chest pain before discharge

• Symptomless after discharge

R d i i f RCA PCI 1 th ft i d • Readmission for RCA PCI 1 month after index

procedure


1-M FU Left Coronary Angiogram


Right Coronary Angiogramg y g g


IVUS imaging of RCA


RCA IVUS ImageRCA IVUS Image

Attenuated Plaque Plaque rupture


RCA PCIRCA PCI

2.5*20mm balloon predilate ,3.0*33mm stent implanted


2.5 20mm balloon predilate ,3.0 33mm stent implanted distally , the 2nd 3.0*33mm stent overlapped with 1st one

RCA PCIRCA PCI

After the 3rd 3 5*29mm stent slow flow occurred


After the 3rd 3.5*29mm stent, slow flow occurred and chest pain again

Final result

3.0*36mm3.0*36mm

Final result

I t l i j t 200 it id th h i


Intracoronaryly inject 200ug nitroprusside through micro-catheter，blood flow restore to TIMI Grade 3

SummarySummary

• PCI strategy• PCI strategy

• Skill tips

• Benefit and risk

• Echolucent plaque and no reflow phenomenon


pci for complex multiple vessel lesion after cabg surgerysummitmd.com/pdf/pdf/1886_after...

Documents