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-140
Spiders & Megatrones
By Jassie Teo, Hoong Sheng Loh, Mohd Tawfeq Mohd Noor, Beni Isman Rusani
Presenter
Jassie Teo
Authors
Jassie Teo1, Hoong Sheng Loh1, Mohd Tawfeq Mohd Noor1, Beni Isman Rusani1
Affiliation
National Heart Institute, Malaysia1,
View Study Report
TCTAP C-140
CORONARY - Stents (Bare-metal, Drug-eluting)
Spiders & Megatrones
Jassie Teo1, Hoong Sheng Loh1, Mohd Tawfeq Mohd Noor1, Beni Isman Rusani1
National Heart Institute, Malaysia1,
Clinical Information
Patient initials or Identifier Number
ZA
Relevant Clinical History and Physical Exam
49yo male, with underlying Diabetes Mellitus and advance chronic kidney disease. Admitted to a local hospital with Acute Inferior STEMI complicated with complete heart block. Patient was transferred to our center after thrombolysis with IV Streptokinase. On arrival patient was ill, requiring inotropic support IVI Noradrenaline.
Relevant Test Results Prior to Catheterization
ECG - Complete heart block with ST elevation II, III, AvF
Hb 9.3 g/dLPlatelet 195WBC 12.6Creatinine 636 umol/lUrea 20.7 mmol/l
Hb 9.3 g/dLPlatelet 195WBC 12.6Creatinine 636 umol/lUrea 20.7 mmol/l
Relevant Catheterization Findings
TPM insertion done. Proceeded with angiogram. Left system showed no obvious obstruction. The right system was engaged with Guide JR 3.5,6F, showed total occlusion of RCA, heavy thrombus in large a caliber RCA. Suction done with PENUMBRA, red thrombus aspirated. We did not proceed with stenting due to heavy thrombus load. Patient was given IV Aggrastat followed by daily S/C Clexane for anticoagulation. Patient was stable in CCU. TPM removed. Restudied 1 week later.
Interventional Management
Procedural Step
Restudied 1 week later. RCA still shows heavy thrombus load. IVUS done. SPIDERFX 5.0mm inserted at distal RCA. Prepare lesion with RYUREI 2.5/15mm. Stented mid segment with MEGATRON 3.5/32mm. Had much difficulty trying to deliver the 2ndstent MEGATRON 4.0/28mm. As we were attempting to deliver the stent, the SPIDERFX migrated up to the level mid RCA into the 1st stent. We then used GUIDEPLUS guide extension to improve support. Successfully delivered stent. IVUS done. Post dilated with NC EMERGE 5.0/8mm, however unable to deliver balloon beyond proximal edge of stent SPIDERFX removed. Upon removal, thrombus found on mesh. RUNTHROUGH FLOPPY sent down RCA. Second wire GRANDSLAM down RCA for better support. IVUS to confirm wire position. Continue to post dilate with NC 5.0/8mm at 8-12atm IVUS done. Then continue dilatation with 6.0/8mm at 8-12atm IVUS done
Case Summary
Issues anticipated prior to procedure: -Large vessel size with high discrepancy between proximal and mid segment, estimated 5-6mm proximally.-Thrombus migration-Difficulty crossing lesion and delivering devices, as encountered during initial angiogram. -Extent of thrombus load maybe under estimated angiographically.Solution for each anticipated problem planned prior to procedure including the deployment of a versatile stent with high expansion capacity.Patient was reviewed 2 months later. Repeat angiography done with IVUS, stent patent with good apposition.