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-051
No Time for Surgeon an Emergency Critical Left Main Primary PCI Using IVUS
By Vijayendran Rajalingam, Dharmaraj Karthikesan, Saravanan Krishinan, Kantha Rao Narasamuloo, Kai Soon Liew, Yuen Hoong Phang, Chee Tat Liew, Tamim Ansari Bin Jahubar Sathik, Pirevina Naidu Krishnan Naidu, Nur Asmalina Binti Azizan, Izzatul Nadzirah Binti Ismail, Ahmad Faiz Mohd Ezanee
Presenter
Vijayendran Rajalingam
Authors
Vijayendran Rajalingam1, Dharmaraj Karthikesan2, Saravanan Krishinan3, Kantha Rao Narasamuloo4, Kai Soon Liew4, Yuen Hoong Phang4, Chee Tat Liew5, Tamim Ansari Bin Jahubar Sathik2, Pirevina Naidu Krishnan Naidu2, Nur Asmalina Binti Azizan2, Izzatul Nadzirah Binti Ismail2, Ahmad Faiz Mohd Ezanee2
Affiliation
Sultan Idris Shah Serdang Hospital, Malaysia1, Hospital Sultanah Bahiyah, Malaysia2, Ministry of Health Malaysia, Malaysia3, Sultanah Bahiyah Hospital, Malaysia4, Pantai Penang Hospital, Malaysia5,
View Study Report
TCTAP C-051
CORONARY - Bifurcation/Left Main Diseases and Intervention
No Time for Surgeon an Emergency Critical Left Main Primary PCI Using IVUS
Vijayendran Rajalingam1, Dharmaraj Karthikesan2, Saravanan Krishinan3, Kantha Rao Narasamuloo4, Kai Soon Liew4, Yuen Hoong Phang4, Chee Tat Liew5, Tamim Ansari Bin Jahubar Sathik2, Pirevina Naidu Krishnan Naidu2, Nur Asmalina Binti Azizan2, Izzatul Nadzirah Binti Ismail2, Ahmad Faiz Mohd Ezanee2
Sultan Idris Shah Serdang Hospital, Malaysia1, Hospital Sultanah Bahiyah, Malaysia2, Ministry of Health Malaysia, Malaysia3, Sultanah Bahiyah Hospital, Malaysia4, Pantai Penang Hospital, Malaysia5,
Clinical Information
Patient initials or Identifier Number
Mr z
Relevant Clinical History and Physical Exam
A 55-Year-Old Male with underlying Diabetes, Hypertension and Active Smoker. Presented to a District Hospital with Chest pain and Diaphoresis.
Relevant Test Results Prior to Catheterization
Fbs 8.1 LDL 3.2 other bloods parameters unremarkable
Echocardiography showed EF 50% , preserved wall thickness
Echocardiography showed EF 50% , preserved wall thickness
Relevant Catheterization Findings
Critical Severe LM Stenosis 99% Ostial LAD 80% mLCX CTO ( collateral from diseased LM ) - ipsilateral anomalous RCA arising from LCC - mRCA CTO giving ipsilateral collateral
Summary Severe 3VD with High Synthax score Plan for Urgent Inpatient bypass surgery (CABG )
however at recovery bay while awaiting bed for admission patient developed sudden chest pain ,became less responsive with ECG changesdecided for urgent Primary Left main Revascularization as we do not have an inhouse cardiac surgeon
Summary Severe 3VD with High Synthax score Plan for Urgent Inpatient bypass surgery (CABG )
however at recovery bay while awaiting bed for admission patient developed sudden chest pain ,became less responsive with ECG changesdecided for urgent Primary Left main Revascularization as we do not have an inhouse cardiac surgeon
Interventional Management
Procedural Step
Femoral approach 7FrEngaged with Short tip JL 4.0 wired into Ramus branch with no touch technique Runthrough floppy into LAD Predilate Left Main stenosis with Sapphire 2.0 x 15mm --> no more chest pain IVUS run into LM - LAD to asses plaque morphology and identify landing zone Decide to intervene CTO LCX first since it has collateral from diseased LM risk of occluding collateral during LM stenting ( Plaque shift )During CTO wiring chest pain again hence used scoreflex balloon 3.5 x15mm to further prepare lesion in the left main.Initially wired using Fielder XTR in a Finecross Microcatheter unsuccessful then escalated to Gaia 1st successfully crossed CTO lesion and exchange with Sion GW via balloon trapprepare lesion at LCX with scoreflex balloon 3.0 x 15mm deployed DEB sequent please 3.0 x 30mm @ nominal mLCXIVUS run into LAD decided for provisional stentingIdentify landing zone before Diagonal ( to prevent jailing retroflex Diagonal )Noted only one Diagonal arising from LAD supplying the anterior lateral wall hence its an important Diagonal cant risk losing proceed with DES 3.5 X 26mm resolute onyx of LM stenting Rewired LCX and Ramus using Dual Lumen to ensure wire within Stent Struts and not entangled during rewiring Final POT with 4.5 X 10 mm @ 28 atm Final IVUS good expansion , no dissection well apposed
Post procedure he remained well Inotropes weaned off no chest pain ,ambulating discharged home 48hours later because we have arranged for an Urgent CTCA to assess the RCA anomaly
Post procedure he remained well Inotropes weaned off no chest pain ,ambulating discharged home 48hours later because we have arranged for an Urgent CTCA to assess the RCA anomaly
Case Summary
1. IVUS in LM Intervention should be made mandatory as its usage help to decide: - Plaque morphology - Choose appropriate stent and balloon size - Identify landing zone < 50% burden - Assess side branch as in this case allowed us to decide on provisional stenting rather then 2 stent technique
2. Operator Experience and Expertise with imaging is important to get equivalent to a CABG like outcome
CTCA confirm RCA is anomalous arising from Left coronary cusp with low interatrial course and mRCA CTO with ipsilateral collateral.He has quit smoking and remained asymptomatic till today and is on Guideline Directed Medical Therapy and is back to his routine job as a Rubber Tapper.
2. Operator Experience and Expertise with imaging is important to get equivalent to a CABG like outcome
CTCA confirm RCA is anomalous arising from Left coronary cusp with low interatrial course and mRCA CTO with ipsilateral collateral.He has quit smoking and remained asymptomatic till today and is on Guideline Directed Medical Therapy and is back to his routine job as a Rubber Tapper.