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-016
Turning Around the Thrombus!
By Osama Shoeib, Amr Elsheikh
Presenter
Osama Shoeib
Authors
Osama Shoeib1, Amr Elsheikh1
Affiliation
Tanta University Hospital, Egypt1,
View Study Report
TCTAP C-016
CORONARY - Acute Coronary Syndromes (STEMI, NSTE-ACS)
Turning Around the Thrombus!
Osama Shoeib1, Amr Elsheikh1
Tanta University Hospital, Egypt1,
Clinical Information
Patient initials or Identifier Number
MG
Relevant Clinical History and Physical Exam
45 years old male patient with previous history of type I DM and no previous cardiac history. presented to our ER with typical anginal pain, his ECG was within normal but his cardiac enzymes were elevated, so he was admitted as non-STEMI.
Relevant Test Results Prior to Catheterization
Both CKMB and troponin were elevated.
Relevant Catheterization Findings
Coronary angiography showed mid segment LAD thrombus (Movie 1) at the bifurcation with sizable diagonal branch with a takeoff that is returning to the back.
1.mp4
1.mp4Interventional Management
Procedural Step
The main challenge was to wire the diagonal branch to protect from thrombus shift, for wiring the diagonal we did with reversed wiring using a plastic jacketed wire to avoid multiple trials that may disturb the thrombus (Movie 2), we successfully managed to wire the diagonal branch with reversed wiring without disrubting the thrombus then we decided for pre-kissing aiming to facilitate the rewiring after stent implantation (figure 1), then regular provisional stenting steps was followed, stent implantation, POT, kissing and then final POT.
2.mp4
final.mp4
pot.mp4
pre kiss.mp4
stent.mp4
2.mp4 final.mp4 pot.mp4 pre kiss.mp4 stent.mp4Case Summary
Reversed wiring with plastic jacketed wire even without microcatheter is feasible and facilitated protection for such diagonal branch with kissing balloon before stent implantation using undersized balloon helped to facilitate diagonal wiring after stent implantation, both simple maneuvers helped to achieve very good final angiographic result in such acute situation.