Lots of interesting abstracts and cases were submitted for TCTAP 2025. 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-197
If You Thought It Was the Last Coronary Angiogram to End PCI, You Might Think Again With IVUS
By Quan Nguyen Manh, Tung Ngo Quang
Presenter
Quan Nguyen Manh
Authors
Quan Nguyen Manh1, Tung Ngo Quang1
Affiliation
Vietnam National Heart Institute, Vietnam1,
View Study Report
TCTAP C-197
Coronary - Imaging & Physiology - Invasive Imaging (IVUS, OCT, NIRS, VH, etc)
If You Thought It Was the Last Coronary Angiogram to End PCI, You Might Think Again With IVUS
Quan Nguyen Manh1, Tung Ngo Quang1
Vietnam National Heart Institute, Vietnam1,
Clinical Information
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
Male, 67 years old, unstable aginaHistory: hypertension treated not usually, and smoking 10 cigarettes per day in 40 years.Physical exam:Glasgow 15 pointsIntermediate agina, NYHA II, KILLIP IHR 70 bpm, BP 140/70 mmHg
Relevant Test Results Prior to Catheterization
ECG: sinus rhythm, right bundle branch block, T negative in V1-V4Echo: EF 41%, decreased movement in many areas of the left ventricular myocardium, especially in 2/3 of the interventricular septum and 2/3 of the anterior wall to apex.Troponin T = 635,1 ng/LNT-ProBNP = 1833.0 pg/mL
Relevant Catheterization Findings
Catheterization:LAD: calcification in LAD1 and 99% stenosis in LAD2, slow flow after stenosisLcx: normalRCA: normal, has little collateral circulation to distal LAD
Interventional Management
Procedural Step
6F, through right radial artery, guiding EBU 3.75, guidewire Runthrough.
Pre-dilated LAD2 by balloon 2.5x20, 12 atm.
Stenting LAD1-2 by Sirolimus stents 3.0x28 and 3.5x33.
Post-dilated by NC balloon 3.0x20 and 3.5x20; 16-20 atm.
The last LAD angiogram before end of PCI, we suspected a mini dissection before stent LAD1.
So we used IVUS to check.
There was a dissection in the LAD1 before the stent, and calcify, atherosclerosis in LM - LAD1
We decided put one more 4.0x26 stent in LM - LAD1.
After IVUS again, we post-dilated by NC balloon 4.0x15, 20 atm and 5.0x12, 14 atm.
The last IVUS the result was good and we did the really last coronary angiogram before end of PCI.
Case Summary
- Post- dilated after stenting, especially in the proximal of stent, within calcify area, might be the reason of dissection.- If you are unsure about the result of the last coronary angiogram, check with an IVUS. It is a simple, effective and necessary solution.