ZBAH

A 62-year-old female, with underlying hypertension, paroxysmal atrial fibrillation, end-stage renal disease on regular hemodialysis, presented with chest pain and shortness of breath. She was diagnosed with a NSTEMI with troponin I 80 ng/L. ECHO showing EF 59%. ECG sinus rhythm with T inversions over the anterior leads. Vital signs were stable and clinical examination was unremarkable. 

RAO CRANIAL DIAGNOSTIC 1.mp4
LAO CRANIAL DIAGNOSTIC.mp4
AP CRANIAL DIAGNOSTIC.mp4

Initial COROS showed 2 vessel disease with a smooth left main stem, LAD proximal to mid showing 50-70% stenosis, Dg1 ostial 80% ( Medina 1/1/1), LCx proximal 60% stenosis, RCA dominant and smooth. 
1ST KBT.mp4
2ND KBT.mp4
2ND POT.mp4

Right Femoral Approach with 6Fr femoral sheath, EBU 3.5 6Fr guide catheter, BMW and Sion blue coronary wires with total 200mls of Omnipaque contrast.The BMW was wired into the LAD and Sion blue wired to the Dg1. The Dg1 was predilated with NC Sapphire balloon 2.5 mm x 15 mm at 14 to 20 atmospheres (ATM). Subsequently, predilatation of LAD was done with a NC Sapphire balloon 3.0 mm x 15 mm at 8 to 26 ATM. The Dg1 was stented using Drug eluting stent (DES) XIENCE Xpedition 2.5 mm x 18 mm deployed at 12 ATM. Next, the stent balloon was removed and Dg1 stent was crushed using a NC Sapphire balloon 3.0 mm x 15 mm at 26 ATM. Then rewiring of Dg1 performed at proximal cells.1^st Kissing Balloon Technique (KBT) done with a NC Sapphire balloon 3.0 mm x 15 mm at 16 ATM in LAD and NC LAXA balloon 2.0 mm x 15 mm at 12 ATM in Dg1. Ostial to proximal LAD was stented with DES XIENCE Xpedition 3.5 mm x 48 mm deployed at 9 ATM. Post dilatation of LAD stent with stent balloon at 18 ATM.1^st POT of LAD stent done with NC Trek balloon 4.0 mm x 15 mm at 18 ATM followed by rewiring of the Dg1 with Sion blue wire. Final KBT done using a NC Sapphire 3.5 mm x 15 mm at 14 ATM in LAD with NC Sapphire 2.5 mm x 15 mm at 14 ATM in Dg1. Final POT of LAD stent done with NC Trek 4.0 mm x 15 mm at 18 ATM and concluded procedure.
FINAL RAO CRANIAL.mp4
FINAL LAO CRANIAL.mp4
FINAL LAO CAUDAL.mp4

Good results were seen on final angiography. Procedure ended with successful PCI to LAD & Dg1 using DK Crush method with patient being discharged from hospital the following day and remaining well on clinic follow up.