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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.,DMKamineni HospitalKamineni HospitalHyderabad, IndiaHyderabad, India

C Hi tC Hi tCase HistoryCase History

72 yr old/male72 yr old/maleHTN Di b tHTN Di b tHTN, DiabetesHTN, DiabetesAcute 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 FCougar, Whisper MS guide wireCougar, Whisper MS guide wireVoyager NC & Maverick BDCVoyager NC & Maverick BDCy gy gEnd. 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


Post LCX stent Angio 2nd lesion in LCX


2ND Stent in LCX Stent covering Ostium of LCX


Balloon crushing stent in LMCA & LCX Ostium

Stent From Covering LMCA Ostiumto Proximal LAD


Stent From Covering LMCA Ostiumto Proximal LAD

Stent Inflation


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