Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-008
Hyperacute Stent Thrombosis During Left Main Stem Intervention
By Shawkat Miro
Presenter
Shawkat Miro
Authors
Shawkat Miro1
Affiliation
Azadi Teaching Hospital, University of Dohuk College of Medicine, Iraq1,
View Study Report
TCTAP C-008
CORONARY - Acute Coronary Syndromes (STEMI, NSTE-ACS)
Hyperacute Stent Thrombosis During Left Main Stem Intervention
Shawkat Miro1
Azadi Teaching Hospital, University of Dohuk College of Medicine, Iraq1,
Clinical Information
Patient initials or Identifier Number
HAA
Relevant Clinical History and Physical Exam
52-year-old male patient presented with recurrent attacks of anginalchest pain even at rest in last 3-4 days - first presentation.
He had family history of ischemic heart disease, hyperlipidemia, and currentsmoker.
On clinical examination; there was nothing relevant.
First ECGs showed dynamic ST changes and second day showed persistent STchanges in chest leads.
After performing serial ECGs and investigations, patient diagnosed as high riskNSTEMI & patient shifted to cath lab for angiography.
He had family history of ischemic heart disease, hyperlipidemia, and currentsmoker.
On clinical examination; there was nothing relevant.
First ECGs showed dynamic ST changes and second day showed persistent STchanges in chest leads.
After performing serial ECGs and investigations, patient diagnosed as high riskNSTEMI & patient shifted to cath lab for angiography.
Relevant Test Results Prior to Catheterization
First day serum troponin was 1.8 ng/ml, and second day was 19.2 ng/ml.Other investigation were normal like renal function test.
Relevant Catheterization Findings
Coronary angiography showed;Critical stenosis of distal Left main stem.Critical stenosis of proximal right coronary artery and non-significant distal lesion.
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coro1 (Converted).mov coro2 (Converted).movInterventional Management
Procedural Step
After discussion with cardiac surgeon and patient already had received dual antiplatelet therapy and the urgency of intervention needed, decision was made for percutaneous coronary intervention of RCA then LMS in same session.Through right radial approach, right coronary artery successfully treated with drug eluting stent (3.5*12 mm) implantation, (video coro4). Then left main stem - left anterior descending artery successfully treated with single DES (3.5*22 mm) implantation and finalized with kissing balloon inflation for ostial circumflex artery jeopardy. During left main intervention, patient developed severe chest pain and hypotension after predilatation. We thought it is due balloon induced dissection and slow flow in LAD but final angio (video coro9) showed retrograde filling of RCA. So right guide catheter was taken again and angio showed hyperacute stent thrombosis (video coro 10). After pre-dilatation at distal edge of stent with 3 mm balloon flow restored and another stent deployed covering distal edge of first stent. Since there is no IVUS in our cath lab, we assumed that a missed dissection is the possible cause of stent thrombosis.Patient was kept on dual antiplatelet therapy, and he was asymptomatic. 24 hours later, he was discharged from hospital.
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coro4 .mov coro9 .mov coro10 .movCase Summary
● On table hyperacute stent thrombosis is a serious complication during multivessel PCI.● Imaging like IVUS or OCT have important role in multivessel PCI probable for detection of missed dissections or malapposition.● Care is needed from operators for early detection of such complication because it may lead to mortality.