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-048

Sever LM (Distal segment ISR) Involving LAD & LCX Treated by OCT Guided DK Crush

By Abdul Kayum Khan

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Presenter

Abdul Kayum Khan

Authors

Abdul Kayum Khan¹

Affiliation

National Heart Foundation of Bangladesh, Bangladesh¹,

View Study Report

TCTAP C-048

CORONARY - Bifurcation/Left Main Diseases and Intervention

Sever LM (Distal segment ISR) Involving LAD & LCX Treated by OCT Guided DK Crush

Abdul Kayum Khan¹

National Heart Foundation of Bangladesh, Bangladesh¹,

Clinical Information

Patient initials or Identifier Number

Mr. X-54 Years

Relevant Clinical History and Physical Exam

Risk Factor; HTN, DM,Ex-Smoker.Present Complaints: Effort in tolerance for 6 month. Chest Painfor 2 month which increase in frequency and duration for last month. He wasadmitted with diagnosed as UA in other hospital. Refereed to us for Check CAG.Past History: Previously he was diagnosed as IHD and CAG done in2014 & advice for Medical Management. Again Check CAG done on 2018,found and SVD. PCI to LAD done with Two DES in 2018.

Relevant Test Results Prior to Catheterization

ECG- Ext-Ant MIEcho- RWMA present at rest. dilated LV. EF-34%Hematological test - Normal.

Relevant Catheterization Findings

LMCA-Having 90-95% in-stent restenosis in its distal segment.

LAD-

Type IV vessel & 90% in-stent restenosis at its origin. Stent in mid LAD is patent.LCX-Dominant having 90-95% stenosis in its origin. OM1 Having 70-80% Stenosis in proximal segment.RCA-Non-dominant & free of disease.

Mr. X-54 Yrs_CAG 1,RAO-CAU.avi

Mr. X-54 Yrs_CAG2 Api-Crenial.avi

Mr. X-54 Yrs_(S3_CAG3 RCA.avi

Interventional Management

Procedural Step

After OCT into LM to LAD, Two Stent Strategies (DK Cruch) were taken. Pre-dilatation of LCX done. LM to LCX stent DES 3.5X 24mm were taken. Another 3X15 mm NC balloon taken in LAD. LCX Stent DEPLOYED. LCX Wire remove and LAD balloon inflation into LM to LAD to cruch the LCX stent. Then LCX was rewire and 1st Kissing done. Again LCX wire remove and DES stent 4X 24mm were taken to LM to LAD. Stent Deployed in 14 ATM covering LM ostium to LAD proximal segment. POT done with 4.5 X 08mm NC ballon. Again rewiring LCX. Final Kissing done. Re-POT to LM . OCT run into LM-LAD and LM to LCX done showed optimum expansion of both stent.

Mr. X-54Yrs_OCT Pre LAD.avi

Mr. X-54Yrs_PCI 14 Final Kiss.avi

Mr.X-54Yrs_PCI 15 Post OCT LM-LAD.avi

Case Summary

Distal LM disease along with ISR is very notorious DiseaseDK –Crush is one of the best strategies for treatment of LM-bifurcation disease,Proper Kissing, POT & Re-POT Increase Outcome OCT Imaging enhance Long term efficacy of DK-Crush

Case

TCTAP C-048