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-083
Over the Hump
By Chanikarn Kanaderm
Presenter
Chanikarn Kanaderm
Authors
Chanikarn Kanaderm1
Affiliation
Central Chest Institute of Thailand, Thailand1,
View Study Report
TCTAP C-083
CORONARY - Complex and Higher Risk Procedures for Indicated Patients (CHIP)
Over the Hump
Chanikarn Kanaderm1
Central Chest Institute of Thailand, Thailand1,
Clinical Information
Patient initials or Identifier Number
Somsri
Relevant Clinical History and Physical Exam
73 years old female, CA breast, recent subarachnoid hemorrhage, HT, DLP presents with angina on exertion (diagnosed with triple vessel disease S/P PCI to proximal LAD, mid LCX, proximal to mid RCA with moderate MR) 25/4/2019 re cag and PCI to LM-LAD with provisional technique,16/10/2019 re admit with NSTEMI and re CAG :90% ostial LCX stenosis patent others previous stent, scheduled for evaluate FFR if positive plan stage PCI to ostial LCX.
History.mp4
History.mp4Relevant Test Results Prior to Catheterization
Blood test FBS 96 mg/dl, LDL 64 mg/dl, CBC : HB 11 gram/dl , HCT 33% normal MCV
ECG NSR, LVH by voltage criteria
Echocardiogram showed mild impair LV systolic function LVEF 56%, anterior/septal/inferoposterior wall hypokinesia, moderate MR.
Relevant Catheterization Findings
CAG : LM ; non significant ISR
LAD ; non significant ISR
LCX ; 70% ostial LCX, 80% distal LCX stenosis
RCA ; non significant ISR, diffuse RCA non significant stenosis, 70-80% diffuse stenosis same as previous study
Coronary angiography.mp4
LAD ; non significant ISR
LCX ; 70% ostial LCX, 80% distal LCX stenosis
RCA ; non significant ISR, diffuse RCA non significant stenosis, 70-80% diffuse stenosis same as previous study
Coronary angiography.mp4Interventional Management
Procedural Step
FFR to ostium LCX with adenosine 50 microgram = 0.73 ( significant lesion )
EBU 7/3.0 was used.
Rotablator 1.5 blur was used to preparation calcium/fibrous tissue (plaque modification)at proximal LCX lesion pass previous LM stent strut.
Predilate with NC 2.5 at proximal LCX lesion.
IVUS check size and stent of LCX, LAD, LM ( LM stent not fully expansion, LAD previous stent ; mild atheroma, LCX cannot pass IVUS)
Kissing balloon with NC 3.5 in lad and NC 2.5 in LCX.
Kissing balloon with NC 3.5 in lad and DCB 2.5 in LCX.
Final angiogram was shown TIMI 3 flow in all coronary vessels.
ivus.mp4
Final kissing balloon.mp4
final angiography.mp4
EBU 7/3.0 was used.
Rotablator 1.5 blur was used to preparation calcium/fibrous tissue (plaque modification)at proximal LCX lesion pass previous LM stent strut.
Predilate with NC 2.5 at proximal LCX lesion.
IVUS check size and stent of LCX, LAD, LM ( LM stent not fully expansion, LAD previous stent ; mild atheroma, LCX cannot pass IVUS)
Kissing balloon with NC 3.5 in lad and NC 2.5 in LCX.
Kissing balloon with NC 3.5 in lad and DCB 2.5 in LCX.
Final angiogram was shown TIMI 3 flow in all coronary vessels.
ivus.mp4 Final kissing balloon.mp4 final angiography.mp4Case Summary
Pre-treatment or plaque modification before stent implantation is an important step to achieved the best possible result.
Calcification of the coronary lesion is a clinical important, aggressive plaque modification such as rotation atherectomy and cutting balloon were significant factor to optimal expansion.
Ostial left circumflex lesion with calcified successful treated with rotation atherectomy and drug coated balloon.
Calcification of the coronary lesion is a clinical important, aggressive plaque modification such as rotation atherectomy and cutting balloon were significant factor to optimal expansion.
Ostial left circumflex lesion with calcified successful treated with rotation atherectomy and drug coated balloon.