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-141

Consideration for Coronary Intervention in a Patient Ankylosing Spondylitis With Anti-TNF Monoclonal Antibody Therapy

By Antonia Anna Lukito, Sonia Chandra, Riyandi Ardi Putra Fernandes, Hardi Hutabarat, Audie Christopher

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Presenter

Hardi Hutabarat

Authors

Antonia Anna Lukito¹, Sonia Chandra¹, Riyandi Ardi Putra Fernandes¹, Hardi Hutabarat¹, Audie Christopher¹

Affiliation

Siloam Hospitals Lippo Village, Indonesia¹,

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TCTAP C-141

CORONARY - Stents (Bare-metal, Drug-eluting)

Consideration for Coronary Intervention in a Patient Ankylosing Spondylitis With Anti-TNF Monoclonal Antibody Therapy

Antonia Anna Lukito¹, Sonia Chandra¹, Riyandi Ardi Putra Fernandes¹, Hardi Hutabarat¹, Audie Christopher¹

Siloam Hospitals Lippo Village, Indonesia¹,

Clinical Information

Patient initials or Identifier Number

Mrs. FW

Relevant Clinical History and Physical Exam

A 52-year-old female presented with angina and back pain for 1 month. CVRFs are hypertension, diabetes, dyslipidemia, and ankylosing spondylitis (HLA-B27 positive) on Golimumab (anti TNF monoclonal antibody) therapy. History of total hysterectomy and oophorectomy bilateral since 5 years ago.

Relevant Test Results Prior to Catheterization

ECG showed normal sinus rhythm and no ST-T segment changes. The CCTA showed three vessels disease with calcium score of 470. Echocardiography revealed no RWMA, with LVEF of 70%.

Relevant Catheterization Findings

Coronary angiography revealed left dominant system and three vessels disease. RCA was non dominant and small in caliber, with 40-50% lesion at mid-distal segment.Left main was normal. There was 30% lesion at proximal-mid LCX and 85% lesion at mid-distal LCX. The 85% and 50% lesions were noted at mid LAD and 45% lesion at distal LAD.

Interventional Management

Procedural Step

Patient was agreed for further intervention procedure.BMW guidewire was inserted through BL 3.5-6F guiding catheter to the target lesion at mid LAD. The MLA was calculated by IVUS and the result was 2.7mm2. Pre-dilation was done with Across HP balloon 2.0-15 mm, proceed with implantation of Biofreedom Ultra DES 3.0-29 mm, followed by post-dilation with NC Sapphire balloon 3.0-12 mm at 14 atm with good result. Post stenting evaluation with IVUS found the MSA of 6.6 mm2, the stent was well-deployed and no stent edge dissection.The BMW guidewire was then inserted into the target lesion at mid-distal LCX. Evaluation with IVUS found MLA of 2.5 mm2. Pre-dilation was done with Across HP balloon 2.0-15 mm, and proceeded with implantation of Biofreedom Ultra DES 2.75-19 mm, followed by post-dilation with NC Sapphire balloon 3.0-12mm at 14 atm with good result. Post stenting evaluation with IVUS found the MSA of 5.5 mm2, the stent was well-deployed and no stent edge dissection.

Case Summary

The consideration for choosing short-DAPT-approved DES for this patient that has the comorbidity of ankylosing spondylitis which need the long-term anti TNF monoclonal antibody therapy (Golimumab) that carries higher risk of bleeding. And second consideration for using IVUS guided DES implantation were for accurate stent sizing and to ensure well-deployed stent and no edge dissection to avoid the potential of both in-stent restenosis and in-stent thrombosis.

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TCTAP C-141