Mdm H

Mdm H, 65years old lady with underlying hypertension presented with central chest pain associated with mild shortness of breath. Blood pressure was 130/70 mmHg with heart rate 80 beats per minute, oxygen saturation 98% under room air and clear lung field. Heart sounds were normal. ECG showed left ventricular hypertrophy pattern with ST depression at lateral leads with normal Troponin T. She was treated as unstable angina and referred to our outpatient clinic for cardiac assessment.

LDL-C: 1.3 mmol/LHDL-C: 1.7 mmol/LTriglyceride: 1.1mmol/LTroponin T: 17 pg/mlHaemoglobin: 14 g/dLurea 3.4 mmol/Lcreatinine: 49 umol/L
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Coronary angiogram showedLeft main stem: normalLeft anterior descending artery: ulcerated plaque with aneurysmal segment at proximal left anterior descending artery Left circumflex artery: severe lesion at mid Left CircumflexRight coronary artery: normal
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Coronary angiogram was performed via right femoral approach using diagnostic catheter JR 3.5/6F and JL 4.0/6F. It showed severe lesion at mid left circumflex artery. We proceeded with percutaneous coronary intervention using EBU 3.0/6F catheter. Runthrough floppy wire was used to cross the lesion in left circumflex artery. Scoring balloon SCOREFLEX NC 2.75/15mm was used to predilate the lesion and inflated at 12-14 atm. After predilatation, there was no dissection and subsequently we used drug eluting balloon SeQuent^R Please Neo 3.0/25mm at the lesion, inflated at nomimal pressure for 1minute. Good result was achieved with TIMI 3 flow. 

This case illustrates the use of drug coated balloon in a patient with de novo coronary lesion. The final angiogram showed a very good result and spares the patient from prolonged use of dual antiplatelet therapy, thereby reducing the potential bleeding risks. She was seen in our follow up clinic recently and is still doing well without any symptoms.