TCTAP 2011 in Seoul

A bailed out case of PCIfor spiral dissection of LMT and LCA

Mimihara General Hospital, Osaka, Japan

Shozo Ishihara, Chasu Ku, Takuji Nishida

Seigo Arima, Hisashi MatsumotoSeigo Arima, Hisashi Matsumoto

Mimihara General Hospital

【Case】 74 y o male【Case】 74 y.o male

【Present Illness】【Present Illness】

2010.6.2 CAG (pre operation of AAA)

→LAD #7) 99% +delay

2010 7 5 O f AAA (Y ft l t)2010.7.5 Ope for AAA (Y-graft replacement)

2010.8.25 admission for PCI

【Coronary Risk Factor】

HT( ) Di li id i ( ) DM( ) ki ( )HT(+) Dislipidemia(+) DM(-) smoking(-)

LDL 150mg/dl HDL 40mg/dlg g

Mimihara General Hospital

【CAG】 RCA #1)50% #2)50%【CAG】 RCA : #1)50%, #2)50%

LAD : #7) 99% +delay , #9)50%) y , )

collateral : RCA to LAD (Rentrop grade 2)

LVG : almost normal

【UCG】【UCG】

slightly hypokinesis at anterior wall, EF=64%

【RI : Tc】

perfusion defect at antero-septum wallperfusion defect at antero septum wall

ischemia(+)

Mimihara General Hospital

LCA

Mimihara General Hospital

LCA

Mimihara General Hospital

RCA

Mimihara General Hospital

PCIPCI

Target Lesion LAD#7) CTO lesion

・approach : rt. RA

・Guideng Catheter ： 7Fr PB 3.75 (sheathless)

Guide Wire ： X treme・Guide Wire ： X-treme

・IVUS ： Volcano Eagle EyeIVUS ： Volcano Eagle Eye

Mimihara General Hospital

LCA (control)

Mimihara General Hospital

Spiral Dissection of LMT !!Mimihara General Hospital

Spiral Dissection of LMT !!

true lumen

Guide wire was in the large false lumen

Mimihara General Hospital

Guide wire was in the large false lumen.

Both IVUS catheter and guide wires are in false lumen

Mimihara General Hospital

Both IVUS catheter and guide wires are in false lumen.

7Fr sheath and guiding catheter (JL4.0) from Rt. Femoral A.

Mimihara General HospitalBy the information of IVUS, I could choose true lumen.

EndeavorEndeavor3.5x18mm 8atm

Mimihara General Hospital

Mimihara General Hospital

Tazuna 2.5x15mm

Mimihara General Hospital1)wireing to LCx by IVUS guide 2)POBA 2.5mm LMT-LCx

KBT3.0mm+2 5mm2.5mm

Stent impantation to diagonal br Endeavor 2.5x24mmEndeavor 2.5x24mm

Mimihara General HospitalProximal LAD: Endeavor 3.0x30mm

IVUS image from proximal LAD to LMT

Large dissection remains at LMTMimihara General Hospital

Large dissection remains at LMT.

Endeavor 3.5x12mm

Mimihara General Hospital3.5mm+2.5mm KBT

Final

Mimihara General Hospital

After PCI

•Slight chest pain continued until next day.g p y

•CPK increased upto 1250 IU/L•CPK increased upto 1250 IU/L.

•LV wall motion in UCG was almost normal.EF=60% pericardial effusion (-)EF=60%, pericardial effusion ( )

Mimihara General Hospital

Forrow up CAG after 3Mo

Mimihara General Hospital

Summeryy

1) W i d f t l li ti1) We experienced a fatal complication case of spiral dissection by sheathless guiding catheter and tapered guide wire.

2) Using another guiding catheter, changing approach site, and IVUS guide technique were helpful for wire crossing to the smallwere helpful for wire crossing to the small true lumen.

Mimihara General Hospital