Lots of interesting abstracts and cases were submitted for TCTAP 2023. 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-131
Should Have Been Easy but Turned Into Nightmare-Graft Angioplasty
By Punish Sadana
Presenter
Punish Sadana
Authors
Punish Sadana1
Affiliation
Max Super Specialty Hospital, India1,
View Study Report
TCTAP C-131
CORONARY - Complications (Coronary)
Should Have Been Easy but Turned Into Nightmare-Graft Angioplasty
Punish Sadana1
Max Super Specialty Hospital, India1,
Clinical Information
Patient initials or Identifier Number
MP
Relevant Clinical History and Physical Exam
A 62 year old male a known case of Hypertension,CAD-Post PTCA to LCX,Post CABG(LIMA to LAD,LRA to RCA) admitted with Angina on exertion class III.There is no history of Diabetes.On Examination-Vitals Stable,Chest/CVS examination -Within normal Limits
Relevant Test Results Prior to Catheterization
ECG -sinus rythm,Q waves in inferior leadsEcho:RWMA in RCA territory,LVEF 35%
Relevant Catheterization Findings
CAG-Native TVD with patent patent LCX stent,LIMA to LAD and 85%stenosis distal to LRA insertion in RCA
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TCTAP C-131_03_0_MOVIE-0001.jpg TCTAP C-131_03_1_MOVIE-0002.jpgInterventional Management
Procedural Step
Patient was planned for PTCA/Stent to distal RCA through LRA graftLRA hooked with JR 4 catheter.Lesion crossed with runthrough guidewire ,another sion blue buddywire taken.Lesion dilated with 2.5x8mm balloon.After predilation no reflow seen .Patient developed chest pain with ECG changes.Thrombosuction done.Intracoronary Nitroprusside and abciximab given through thrombosuction catheter.Lesion agin predilated.As stenting was not crossing the proximal portion of LRA guideliner support taken and 2.5x18mm DEs deployed with good TIMI III flow.
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TCTAP C-131_04_0_MOVIE-0003.jpg TCTAP C-131_04_1_MOVIE-0004.jpg TCTAP C-131_04_2_MOVIE-0006.jpgCase Summary
Abnormal origin of Graft required use of buddy wire for passage of devicesNo reflow or slow can occurs-causes include distal embolization of atherothrombotic debris,thrombus formation and endothrlial dysfunction of distal bed.It is associated with worse prognosisNo reflow can be managed by thrombosuction and intracoronary GP IIb /IIIa inhibitors and vasodilatorsGuideliner support for stent crossing might be helpful for giving support in case of proximal tortuosity