Primary AngioplastyPrimary Angioplasty involving Left Primary AngioplastyPrimary Angioplasty...

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Transcript of Primary AngioplastyPrimary Angioplasty involving Left Primary AngioplastyPrimary Angioplasty...

  • Primary AngioplastyPrimary AngioplastyPrimary Angioplasty Primary Angioplasty involving Left Maininvolving Left Main

    Dr.Shailendra Singh MD.,DMDr.Shailendra Singh MD.,DMDr.Shailendra Singh MD.,DMDr.Shailendra Singh MD.,DM Kamineni HospitalKamineni Hospital Hyderabad, IndiaHyderabad, India

  • C Hi tC Hi tCase HistoryCase History

    72 yr old/male72 yr old/male HTN Di b tHTN Di b tHTN, DiabetesHTN, Diabetes Acute Chest pain 4 hours duration with BP Acute Chest pain 4 hours duration with BP 80/6080/6080/60.80/60. ECG Shows ST elevation inferio letral Lead.ECG Shows ST elevation inferio letral Lead.

  • Ch llCh llChallengesChallenges

    Patient presented in Cardiogenic shock Patient presented in Cardiogenic shock with acute inferioletral MI.with acute inferioletral MI. Involving Left Main LesionInvolving Left Main LesionInvolving Left Main Lesion.Involving Left Main Lesion.

  • InterventionalInterventionalInterventional Interventional ManagementManagement

    EBU 3.5, 7 FEBU 3.5, 7 F Cougar, Whisper MS guide wireCougar, Whisper MS guide wire Voyager NC & Maverick BDCVoyager NC & Maverick BDCy gy g End. Res. 2.5x18,3.0x18,3.5x18 mm End. Res. 2.5x18,3.0x18,3.5x18 mm

  • I t ti l P dI t ti l P dInterventional ProcedureInterventional Procedure

    Non dominant RCA Ostial LAD & Ostial LCX tight lesion

  • I t ti l P dI t ti l P dInterventional ProcedureInterventional Procedure

    Left main dissected plaque GW in LAD & LCX

  • C tiC tiContinue…Continue…

    Stent placement in LCX Stent Inflation

  • C tiC tiContinue…Continue…

    Post LCX stent Angio 2nd lesion in LCX

  • C tiC tiContinue…Continue…

    2ND Stent in LCX Stent covering Ostium of LCX

  • C tiC tiContinue…Continue…

    Balloon crushing stent in LMCA & LCX Ostium

    Stent From Covering LMCA Ostium to Proximal LAD

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    Stent From Covering LMCA Ostium to Proximal LAD

    Stent Inflation

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    After Recrossing the GW kissing balloon dilatation

    Final Result

  • T k HT k HTake Home messageTake Home message

    Left Main bifurcation Stenting in the setting Left Main bifurcation Stenting in the setting f AMI & C di i h k b df AMI & C di i h k b dof AMI & Cardiogenic shock can be done of AMI & Cardiogenic shock can be done

    with reasonable safety by minicrush with reasonable safety by minicrush t h it h itechnique.technique. Patient Follow up next day morning was Patient Follow up next day morning was taken out & patent reasonably well & taken out & patent reasonably well & discharged on day 5.discharged on day 5. 6 Month follow up TMT Negative & patent 6 Month follow up TMT Negative & patent asymptamatic.asymptamatic.y py p