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Lots of interesting abstracts and cases were submitted for TCTAP 2021 Virtual. Below are accepted ones after thoroughly reviewed by our official reviewers. Don’t miss the opportunity to explore your knowledge and interact with authors as well as virtual participants by sharing your opinion!

TCTAP C-028

Presenter

Seng Hsiung Toh

Authors

Seng Hsiung Toh1, Chong Wei Loong2, Houng Bang Liew2

Affiliation

Queen Elizabeth II, Malaysia1, Queen Elizabeth II Hospital, Malaysia2,
View Study Report
TCTAP C-028
CORONARY - Bifurcation/Left Main Diseases and Intervention

Intravascular Ultrasound (IVUS) Guided Left Main and Anterior Descending Intervention

Seng Hsiung Toh1, Chong Wei Loong2, Houng Bang Liew2

Queen Elizabeth II, Malaysia1, Queen Elizabeth II Hospital, Malaysia2,

Clinical Information

Patient initials or Identifier Number

SB

Relevant Clinical History and Physical Exam

58 years old gentleman, with no previous medical illness, non-smoking, with a family history of ischemic heart disease, presented to a non-PCI abled district hospital for Non-ST Elevation Myocardial Infarct in May 2019. He was electively admitted in August 2019 for coronary angiography. New York Heart functional class I, Canadian Cardiac Society functional class I, SYNTAX score 28, and ACR-HBR low risk. Blood pressure 114/78 mmHg and heart rate 78 beats per minute.

Relevant Test Results Prior to Catheterization

Creatinine 90 umol/L.Hemoglobin 13.3 g/dL.Platelet 243 x 109/L.Creatine kinase 800 IU/L.Electrocardiogram in August 2019 showed resolved ST segment depression in leads V3-6.Echocardiography showed left ventricular ejection fraction of 45-50%.

Relevant Catheterization Findings

Left main stem tapering disease 70-80%.Left anterior descending diffuse disease with proximal 99% stenosis before first diagonal. Diagonal small and normal.Left circumflex non-dominant and small.Right coronary mid-segment 50-60%, 90% stenosis posterior descending artery. Posterior left ventricular artery normal.
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Interventional Management

Procedural Step

Multi-view diagnostic coronary angiography performed with TERUMO TIG 5 French.
  1. Right radial access via sheath RADIAL 6 French.
  2. Multi-view diagnostic coronary angiography performed with TERUMO TIG 5 French.
  3. Decision for Ad hoc percutaneous coronary intervention (PCI) to Left Main (LM) -Left Anterior Descending (LAD) Artery.
  4. Radial sheath exchanged to 7 French RADIAL.
  5. EBU 3.5 7 French guide catheter was used to engage the left coronary artery.
  6. BMW Universal II 0.014” x 190 cm coronary guidewire was passed into the Left Anterior Descending.
  7. Left Anterior Descending predilated with SAPPHIRE II 2.5 x 12 mm to improve flow.
  8. Left Circumflex Artery was protected with a second BMW Universal II 0.014” x 190 cm.
  9. Intravascular ultrasound (IVUS) imaging performed with Volcano Eagle Eye catheter.
  10. LM-LAD pre-dilated with SAPPHIRE II NC 3.5 x 15mm.
  11. LM-LAD stented with overlapping FIREHAWK 3.0 x 33 mm and 3.5 x 33 mm drug eluting stents.
  12. Stents were post dilated with SAPPHIRE II NC 3.5 x 15mm and SAPPHIRE II NC 4.5 x 15 mm.
  13. Post PCI IVUS was performed to evaluate stents and vessel.

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Case Summary

Intravascular Ultrasound (IVUS) guided Left Main Coronary Artery (LMCA) intervention, as highlighted in the European Bifurcation Club’s Consensus, has several benefits such as 1) enabling proper sizing of vessel and stent, 2) determining stent landing area, 3) post procedural stent optimization, and 4) statistically is associated with a reduction in all-cause mortality, target lesion restenosis, and in-stent restenosis.

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