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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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Interventional 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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Case 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