E-Case

JACC

Lots of interesting abstracts and cases were submitted for TCTAP 2024. 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-020

Keeping It Simple

By Swee En Goay, Noor Yuhyi Sulaiman, Chan Ho Thum, Azhari Rosman

Presenter

Swee En Goay

Authors

Swee En Goay1, Noor Yuhyi Sulaiman1, Chan Ho Thum1, Azhari Rosman1

Affiliation

National Heart Institute, Malaysia1,
View Study Report
TCTAP C-020
Coronary - Adjunctive Procedures (Thrombectomy, Atherectomy, Special Balloons)

Keeping It Simple

Swee En Goay1, Noor Yuhyi Sulaiman1, Chan Ho Thum1, Azhari Rosman1

National Heart Institute, Malaysia1,

Clinical Information

Patient initials or Identifier Number

Relevant Clinical History and Physical Exam

65 years old gentleman, ex-smoker presented with worsening chest pain and treated for Unstable Angina. He has Hypertension & Dyslipidaemia and had previous coronary angioplasty to LAD and RCA in 2008. 

Relevant Test Results Prior to Catheterization

Echocardiogram showed 40% with regional wall motion abnormalities. Technetium nuclear imaging showed abnormal perfusion study with stress induced ischaemia detected at mid right coronary artery.

Relevant Catheterization Findings

Coronary angiogram showed mild left main stem disease with moderate ISR proximal LAD stent (QFR 0.90) with mild disease at proximal LCx and severe calcification stenosis at mid RCA distal to RCA stent (QFR 0.77). IVUS study showed circumferential calcification.


Interventional Management

Procedural Step

Using JR3.5/7Fr guiding catheter, we crossed the mid RCA lesion with run through floppy workhorse wire. Intravascular lithotripsy Shockwave (IVL) 3.0/12mm was delivered for 8 cycles before further predilate the lesion with SCOREFLEX 3.0/15mm up to 20atm followed by SCOREFLEX3.5/15mm up to 20atm.  After adequate lesion preparation, we stented the lesion with DES CRE8 EVO 3.5/26 mm and post dilate with ACCUFORCE 4.0/12mm up to 18atm. 
Final IVUS study showed a well opposed stent with no dissection. Repeated QFR post PCI was 0.97. 


Case Summary

Patient was discharged home well the next day and remained well during his follow-up. Intravascular lithotripsy (IVL) is a novel approach to lesion preparation of severely calcified plaques in coronary vessels. It is relatively simple to perform and safely modify calcium while significantly reducing the risk of complications to make procedures more predictable and efficient.
Mohammad Shafiqur Rahman Patwary (NATIONAL INSTITUTE OF CARDIOVASCULAR DISEASES) Apr 25, 2024
Excellent case, IVL is the key to success the procedure.