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-108
Coronary Artery Perforation Successfully Treated With a Stent Graft and Second Drug-Eluting Stent
By Chanikarn Kanaderm
Presenter
Chanikarn Kanaderm
Authors
Chanikarn Kanaderm1
Affiliation
Central Chest Institute of Thailand, Thailand1,
View Study Report
TCTAP C-108
Coronary - Complication Management
Coronary Artery Perforation Successfully Treated With a Stent Graft and Second Drug-Eluting Stent
Chanikarn Kanaderm1
Central Chest Institute of Thailand, Thailand1,
Clinical Information
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
A Thai female 84 years old,denied underlying disease (never check up).Presented withretrosternal chest pain 2hours PTA• Initial vital signs : BP 100/60, HR 75/min, RR 20/min Physical exam : good consciousness, JVP not engorged, normal s1s2, no murmur,normal breath sounds, no pitting edema
Relevant Test Results Prior to Catheterization
ECG 12 leads : ST elevation in II, III, aVF and depression in lead I, aVL.CXR : Marked cardiomegaly.Echocardiography : Poor LV systolic function EF 18% with inferior and inferoseptal wall hypokinesia.
Relevant Catheterization Findings
LM : normalLAD : 90% proximal LAD: stenosis,Non significant DG and septalbranch LCX : non significant RCA : 95% stenosis of proximal RCAwith filling defect
Interventional Management
Procedural Step
Primary PCI to RCAGD : Launcher SAL 1.0GW Wire : SION and Run through NS Hypercoat Balloon (Sprinter legend 2.0*12 mm) wasinflated at distal RCA (12 atm) and proximalRCA (12 atm) Stents :- Biometrix Alpha 2.5*36 mm at pRCA- Firehawk 3.0*13 mm at ostial RCA- Biometrix Alpha 3.0*9 mm at ostial RCAThe angiogram show perforation ostial RCA.Management for ostial RCA perforation Balloon Tasuki 4.0 * 8 mm (18 atm)- Stent graft PK papyrus 3.5 * 15 mm(16 atm)Post dilated with- Tasuki 3.0 * 21 mm, inflated at p-mRCA (20 atm) and at ostial RCA (20 atm)- Tasuki 4.0 * 8 mm at ostial RCA (18atm)- NC Trek 4.5 * 8 mm at ostial RCA (16atm)Stent : the 5th stent (Biometrix Alpha4.0*9 mm, 14 atm) at ostial RCABalloon NC Trek 4.5 * 8 mm (18 atm)The final angiogram show no residual leakage.
Case Summary
-Gentle manipulate when use extra support guiding .-Utilization of Sepal technique to prevent trauma from tip of catheter and precise for stent at ostial RCA .-Difficult differential diagnosis between aorto-ostial dissection and ostial perforation.-The stent graft will help in perforation situation.-The second DES may be help if the leakage still continue.