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JACC

Lots of interesting abstracts and cases were submitted for TCTAP 2023. 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-122

A Challenging Case Report: Multiple Complications in Three Consecutive Sessions

By Chun-Ting Shih, Chiung-Jen Wu

Presenter

Chun-Ting Shih

Authors

Chun-Ting Shih1, Chiung-Jen Wu1

Affiliation

Kaohsiung Chang Gung Memorial Hospital, Taiwan1,
View Study Report
TCTAP C-122
CORONARY - Complications (Coronary)

A Challenging Case Report: Multiple Complications in Three Consecutive Sessions

Chun-Ting Shih1, Chiung-Jen Wu1

Kaohsiung Chang Gung Memorial Hospital, Taiwan1,

Clinical Information

Patient initials or Identifier Number

ID of KCGMH: 60483297 ; Mr. Dai

Relevant Clinical History and Physical Exam

. This 76 y/o male with HCVD and hyperlipidemia presented to a cardiologist with UAP.. (+) Thallium.
. Preserved LV function (EF = 65%) s/p elective Dx cath. Via RFA. Neither renal insufficiency nor coagulopathy was revealed.. The patient remained in the throes of crescendo angina after two sessions of PCI carried out at two separate hospitals.. He was referred to our hospital for the 3rd session of PCI.

Relevant Test Results Prior to Catheterization

none

Relevant Catheterization Findings

. LAD CTO, critical lesions in RCA and LCx were detected.
. Pinhole balloon rupture was already observed during the previous session. 


Interventional Management

Procedural Step

. Given the failure to perform antegrade wiring of the LAD artery during the first and second sessions, retrograde wiring was intended from PDA to LAD through septal branches. . During the 3rd session of PCI, hematomas were noted in two of the aforementioned branches.. With the PL branch involved, balloon anchoring technique was employed to enhance the support of the guiding catheter. . A hematoma was observed again at the anterior branch. . On account of massive pericardial effusion and hemodynamic instability, emergency pericardiocentesis was carried out.


Case Summary

. Residual hematomas were still noted.. The coronary angiography showed the absence of distal RCA in the 3rd session.. On account of significant vascular calcification, no retrograde wiring was feasible.. PCI to d-RCA and p-RCA rather than LAD was carried out as a result.. Eventually, intramural hematomas and dissection involving PDA were detected. . The LAD CTO remained an unsolved problem.. Whether PCI should be carried out for the 4th time remains undecided.