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-125
How MCS Save Lives
By Ka Hei Ho
Presenter
Ka Hei Ho
Authors
Ka Hei Ho1
Affiliation
Tuen Mun Hospital, Hong Kong, China1,
View Study Report
TCTAP C-125
CORONARY - Hemodynamic Support and Cardiogenic Shock
How MCS Save Lives
Ka Hei Ho1
Tuen Mun Hospital, Hong Kong, China1,
Clinical Information
Patient initials or Identifier Number
CWY
Relevant Clinical History and Physical Exam
A 58-year-old gentleman, with good past health, was found lying on floor. Upon arrival to the Emergency Department, he was hypotensive and confused. He developed desaturation requiring intubation. ECG showed ST elevation over inferoposterior leads. Despite fluid resuscitation, patient remained in profound shock and required double inotropes to stabilise haemodynamics. He was immediately transferred to catheterization laboratory for primary PCI.
Relevant Test Results Prior to Catheterization
Bedside echocardiogram showed severely impaired LV systolic function with EF 20% with global hypokinesia. CXR was congested. Trop I was only mildly elevated. Lactate was markedly elevated.
Relevant Catheterization Findings
Left main: normalLAD: Diffuse 60% stenosis at proximal LAD, long diffuse 90% stenosis at mid LAD, critical stenosis at distal LAD. LCx: mid LCx acute total occlusionRCA: Normal and non-dominant.
Interventional Management
Procedural Step
Patient developed PEA arrest upon arrival to catheterization laboratory. CPR was started and ECMO was inserted immediately. We proceeded to PCI after ECMO insertion. JL 4.0 was used as guiding catheter. LCx was wired with Runthrough NS and angiogram showed ectatic vessel with critical stenosis at mid LCx and OM2. Both lesions were predilated with compliant balloon. Biofreedom 3.5/24 was deployed at distal LCx-OM2 due to significant vessel size mismatch. Biofreedom 3.5/33 was deployed at proximal to mid LCx. No-reflow was noted after post-dilatation. Multiple boluses of adenoscan was given and TIMI III flow was restored. LAD and diagonal was then wired with Runthrough NS. The lesions were predilated with 2.0/10 compliant balloon. Biofreedom 2.25/29 was deployed at distal LAD and Biofreedom 3.0/42 was deployed at ostial LAD to mid LAD. However after stenting, there was distal stent edge dissection noted on angiogram, therefore another Biofreedom 3.0/19 was deployed at proximal LAD. The stent was post-dilated with NC 3.0/10 and angiogram showed excellent result. Impella was implanted for left ventricle venting.Patient was weaned off from ECMO three days after PCI and Impella was weaned off ten days after PCI.
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coro 1.wmv coro 2.wmv final angiogram.wmvCase Summary
We presented a case of inferoposterior STEMI with severe cardiogenic shock. Mechanical circulatory support (MCS) was implanted before PCI to stabilise haemodynamics. Without MCS, the patient's life would be hanging by a thread as any complications from PCI (for example in our case- no reflow, stent edge dissection) could be devastating.