Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP C-070

Chip Revascularization With Mechanical Circulatory Support

By Jonathan Xinguo Fang

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Presenter

Jonathan Fang

Authors

Jonathan Xinguo Fang¹

Affiliation

Henry Ford Health,USA, Hong Kong, China¹,

View Study Report

TCTAP C-070

CORONARY - Complex and Higher Risk Procedures for Indicated Patients (CHIP)

Chip Revascularization With Mechanical Circulatory Support

Jonathan Xinguo Fang¹

Henry Ford Health,USA, Hong Kong, China¹,

Clinical Information

Patient initials or Identifier Number

JWP

Relevant Clinical History and Physical Exam

82-year-old man with history of hypertension and smoking presents with fall and sustained right hip fracture. Shortly after admission, he experienced chest pain. Cardiology was consulted by the orthopedic surgeon. Chest was clear on auscultation. There was a grade 3/6 pansystolic murmur at the apex. The jugular venous pressure was not elevated.

Relevant Test Results Prior to Catheterization

ECG showed inferior and lateral leads ST depression and aVR ST elevation.Echocardiogram showed global hypokinesia with EF 30~35%. Thallium scan showed viable myocardium with ischemia in anterior segments, inferior segments and apex.Chest x-ray showed clear lung fields.Right hip fracture was noted. Non-ST elevation acute coronary syndrome was diagnosed first.

Relevant Catheterization Findings

RCA CTO. LAD aneurysmal
Left main coronary artery was heavily calcified with diffuse 60% disease. Left main-LAD-LCx showed Medina 1,1,1 disease. LAD showed heavily calcified 70-90% tortuous disease and aneurysmal change. D1 bifurcation showed 70% disease with m-dLAD with good target. Circumflex showed ostial 60-70% disease. OM1 and OM2 shows ostial 90% disease. Good target for CABG. RCA showed ostial 90% disease with pressure damping. Proximal RCA CTO with J-.

Interventional Management

Procedural Step

Left femoral access in view of right hip fracture. USG-guided puncture.

Preclose with 2 proglide. 14 French sheath and Impella CP.

PCI to RCA CTO

7 French AL 0.75 guide. JL4 diagnostic for contralateral injection

Turnpike 135 with Fielder XTA followed by Gaia 2nd antegrade wire escalation to RCA true lumen. Exchange to Sion Blue. Balloon with 2.0 balloon. Further balloon with NC scoreflex 2.5. Stent with Resolute Onyx 2.5/38 , 3.0/26, 3.5/22. Postdialte with NC 3.5 at 20 atm and NC 4.0 at 16 atm

mRCA postdilate with NC 3.0 and 2.5 balloon at 22 atm. distal stent edge dissection noted, stented with Resolute Onyx 2.5/18.

PCI to LM-LAD. Rotablation with 1.5 burr at 180000 rpm 8 passes, 1.75 burr at 170000 for 3 passes. Exchange to Sion Blue wire. Runthrough NS wire to LCx.

IVUS done to LM-LAD and LCx showed aneursymal disease and calcification.

LM-LAD dilated with NC Scoreflex 2.5, stent with Resolute Onyx 2.75/35. LM-LAD stent with Resolute Onyx 3.5/34. POT with NC 4.0 at 16 atm. LAD post dilate with NC 3.0 at 22 atm, NC 3.5 at 16 atm. IVUS and angiograms showed good result. Impella weaned and wound closed with Perclose x 2.

Case Summary

Complex PCI with Impella support in high-risk indicated patient can be life-saving with careful procedural planning and case selection. In this patient with ACS and hip fracture, timely revascularization is crucial. In this patient, despite coronary revascularization, the hip fracture was managed conservatively. The hip healed with malunion. Nevertheless, the patient was able to go under rehabilitation program and regain some of his mobility and weight-bearing. Today he can walk with a frame.

Case

TCTAP C-070