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CASE20191113_001
CORONARY - Bifurcation/Left Main Diseases and Intervention
Tough Call in Cath Lab
Debasis Mitra1
NH-RTIICS, India1,
[Clinical Information]
- Patient initials or identifier number:
YA
-Relevant clinical history and physical exam:
51-year-old male
Hypertensive, non-diabetic
Complain of recurrent chest pain, jaw pain with sweating after food, sometimes angina early morning
Smoker
PTCA to LAD & LCX, 2nd generation DES on June 2019
ECG: Normal, V5, V6
LVEF: 65%


-Relevant test results prior to catheterization:
- Relevant catheterization findings:
RCA: Normal
LM: 90% stenosis
LAD: Patient stent with minor late loss

Angio.avi
[Interventional Management]
- Procedural step:
Femoral approach
JL 3.5 (6F) guide catheter 
SION blue PTCA Wire for LAD & for sinus for precise positioning of ostial LM stent 
Semi-complaint balloon for pre-dilatation 2.5*12 MM followed by 3.5*12 MM at 16 ATM
Pre PCI IVUS pull back from LAD to LM - Fibro calcified plaque covering almost 270 degree with a plaque burden of 58% and MLA = 3.86 MM square  
DES: 4*13 MM At 10 ATM 
Post-dilatation done with 4.5*8 MM NC balloon at 15 ATM 
Post-stenting IVUS pull back done 
Post-stenting IVUS showed good apposition with proper expansion of stent



Run10.avi
IVUS-8.wmv
- Case Summary:
LM disease when detected during angiography is usually managed through heart team for discussion / decision. However in unstable patient with recurrent symptoms or in patients where CABG is not possible, Adhoc PTCA stenting with IVUS study to be done.
IVUS helps in decision making for pre-PCI strategy.
Proper stent sizing and stent apposition with respect to achieving MLA is better achieved with IVUS.
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