Lots of interesting abstracts and cases were submitted for TCTAP 2026. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge!
CASE20251020_001
Squeezed to Death... Almost
By Ka Hung Lau
Presenter
Ka Hung Lau
Authors
Ka Hung Lau1
Affiliation
Caritas Medical Centre, Hong Kong, China1
View Study Report
CASE20251020_001
Coronary - Complication Management
Squeezed to Death... Almost
Ka Hung Lau1
Caritas Medical Centre, Hong Kong, China1
Clinical Information
Relevant Clinical History and Physical Exam
71/M
No known allergy
Chronic smoker, retired electrical engineer
HT, hyperlipidaemia, obesity, gout, left ureteric stone
IHD
PCI 28/8/2017: dRCA-pPDA (Biomatrix Alpha 3.0 x 24mm), dLAD (Biomatrix Alpha 3.0 x 19mm)
PCI 16/7/2021: mLCx-pOM1(Ultimaster Tansei 2.25 x 18mm), dLAD ISR CTO (Sequent Please Neo DCB 2.5 x 20mm)
Relevant Test Results Prior to Catheterization
Recurrent angina since early 2025
Relevant Catheterization Findings
Restudy coro 21/8/2025: LM moderate disease pLAD severe disease, mLAD diffuse mild to moderate disease, dLAD stent tight recurrent ISRmLCx-OM1 stent minor ISRRCA diffuse mild disease, dRCA-pPDA stent patent
CKK coro 21.8.25.mov
CKK coro 21.8.25_2.mov
CKK coro 21.8.25_3.mov
CKK coro 21.8.25.mov CKK coro 21.8.25_2.mov CKK coro 21.8.25_3.movInterventional Management
Procedural Step
PTCS to dLAD with Xience Skypoint 3.0/18mm
Developed persistent chest pain and shockCoro: diffuse severe spasm at o-pLADEcho: LVEF satisfactory, no pericardial effusion Given IV fluid, dopamine, adrenaline, noradrenaline
PTCS to to LM-pLAD with Xience Skypoint 4.0 x 38mm
New diffuse spasm proximal to new dLAD stent, retrograde flow to PDA, LCx spasmIVUS: stent under-expansion at LM and pLADSevere spasm at m-dRCA, given IC GTNThen new focal spasm at pRCA and RCA, put on IV GTN infusion
Refractory chest pain and shockIncreasing doses of vasopressors and inotropesSedated and intubated IABP via RFA Preparing escalation of MCS to Impella or ECMODiffuse erythematous maculopapular eruption over trunk and upper limbs, ?allergy / anaphylaxis, given IV steroid, haemodynamics improved
Restudy coro + PCI 26/8/2025LAD, LCx and RCA spasm resolvedLM-pLAD, dLAD stents patentLM-pLAD optimised with 4.0/12 NC balloon
Wean off IABP, vasopressor, inotrope, extubated 27/8/2025Serum tryptase elevatedDischarged on 4/9/2025, referred to allergy specialist
CKK mRCA spasm 25.8.mov
CKK opLAD spasm 25.8.avi
CKK pRCA spasm 25.8.mov
Developed persistent chest pain and shockCoro: diffuse severe spasm at o-pLADEcho: LVEF satisfactory, no pericardial effusion Given IV fluid, dopamine, adrenaline, noradrenaline
PTCS to to LM-pLAD with Xience Skypoint 4.0 x 38mm
New diffuse spasm proximal to new dLAD stent, retrograde flow to PDA, LCx spasmIVUS: stent under-expansion at LM and pLADSevere spasm at m-dRCA, given IC GTNThen new focal spasm at pRCA and RCA, put on IV GTN infusion
Refractory chest pain and shockIncreasing doses of vasopressors and inotropesSedated and intubated IABP via RFA Preparing escalation of MCS to Impella or ECMODiffuse erythematous maculopapular eruption over trunk and upper limbs, ?allergy / anaphylaxis, given IV steroid, haemodynamics improved
Restudy coro + PCI 26/8/2025LAD, LCx and RCA spasm resolvedLM-pLAD, dLAD stents patentLM-pLAD optimised with 4.0/12 NC balloon
Wean off IABP, vasopressor, inotrope, extubated 27/8/2025Serum tryptase elevatedDischarged on 4/9/2025, referred to allergy specialist
CKK mRCA spasm 25.8.mov CKK opLAD spasm 25.8.avi CKK pRCA spasm 25.8.movCase Summary
Severe TVD with PCI done in 2017 and 2021 with DES and DCB, uneventful
PTCS to dLAD ISR 25/8/2025, complicated with severe multifocal coronary spasm with shock
Skin eruption and elevated serum tryptase compatible with allergic reaction
Diagnosis: Type I Kounis syndrome
PTCS to dLAD ISR 25/8/2025, complicated with severe multifocal coronary spasm with shock
Skin eruption and elevated serum tryptase compatible with allergic reaction
Diagnosis: Type I Kounis syndrome