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-036
Complicated Left Main Intervention- Think Twice and Look Twice
By Alexander Goldberg
Presenter
Alexander Goldberg
Authors
Alexander Goldberg1
Affiliation
Ziv Medical Center, Israel1,
View Study Report
TCTAP C-036
CORONARY - Bifurcation/Left Main Diseases and Intervention
Complicated Left Main Intervention- Think Twice and Look Twice
Alexander Goldberg1
Ziv Medical Center, Israel1,
Clinical Information
Patient initials or Identifier Number
M.L.
Relevant Clinical History and Physical Exam
Male 79 y/o patient in a very good general condition. At coronary angio a year ago- borderline LM disease, significant LCX and OM disease. CTO of RCA. Underwent stenting of OM and LCX. Presented with typical angina on BB and CCB. Near normal Echo study. EST positive for ischemia with high risk features.
media1.mp4 media2.mp4Relevant Test Results Prior to Catheterization
Relevant Catheterization Findings
Coronary angiography - Distal LM 70%, patent stents in LCX and OM. very good collaterals from Diagonal branch to RCA. IVUS to LM – MLA= 3.0 MM2. Refused CABG.
Interventional Management
Procedural Step
After predilatation with Euphora 2.5/12 balloon - dissection of LM in direction of both LAD and LCX with slow flow, bradycardia and shock. Started on dopamine, atropine, fentanyl. Stent Onyx 3/15 from LM toLAD- improved flow in LAD but cessation of flow in LCX. PTCA with Euphora 2/5 balloon to Ostial LCX underneath stent struts with restoration of flow in LCX. Difficult rewiring of LCX and PTCA with 2/12 balloon. T-stenting of LCX with Ultimaster 3/12, kissing balloons and POT with 4/8 NC balloon. Good final result with rapid hemodinamic stabilization. The patient was placed in ICCU with tirofiban infusion for 48 hours and was completely asymptomatic. Planned second-look coronarography: thrombi at LM bifurcation in both directions despite triple antiplatelet therapy. IVUS - good stents apposition but underexpansion of LCX stent. Again- kissing non-compliant balloons and POT. Good angiographic result. Clopidogrel substituted by prasugrel. Echocardiography during hospitalization - EF 50%, inferolateral WMA, moderate to severe MR. Echo in 3 months - very mild inferolateral hypokinesis, normal EF, no MR. Asymptomatic exept mild dyspnea. In one year- patent stents in coronary angiography. placed on prolonged therapy with aspirin and clopidogrel.
media3.mp4
media4.mp4
media3.mp4 media4.mp4Case Summary
Calcified eccentric distal LM lesions are prone to complications. In case of acute side branch closure, PTCA underneath the struts of main branch stent is useful. In cases of complicated emergent LM intervention, second-look angiography with intra-coronary imaging and optimization is advised.