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-179

A Glimpse of Light at the End of Tunnel

By Huan Yean Kang, Kai Soon Liew, Vijayendran Rajalingam, Yuen Hoong Phang, Kenneth Kay Leong Khoo, Aditya Fahmi Prianda, Chai Yih Tan, Kantha Rao Narasamuloo, Saravanan Krishinan, Chee Tat Liew, Dharmaraj Karthikesan

Presenter

Huan Yean Kang

Authors

Huan Yean Kang1, Kai Soon Liew1, Vijayendran Rajalingam2, Yuen Hoong Phang1, Kenneth Kay Leong Khoo1, Aditya Fahmi Prianda3, Chai Yih Tan1, Kantha Rao Narasamuloo1, Saravanan Krishinan4, Chee Tat Liew5, Dharmaraj Karthikesan6

Affiliation

Sultanah Bahiyah Hospital, Malaysia1, Sultan Idris Shah Serdang Hospital, Malaysia2, Hasna Medika Kuningan Heart Hospital, Indonesia3, Ministry of Health Malaysia, Malaysia4, Pantai Penang Hospital, Malaysia5, Hospital Sultanah Bahiyah, Malaysia6,
View Study Report
TCTAP C-179
Coronary - Imaging & Physiology - Invasive Imaging (IVUS, OCT, NIRS, VH, etc)

A Glimpse of Light at the End of Tunnel

Huan Yean Kang1, Kai Soon Liew1, Vijayendran Rajalingam2, Yuen Hoong Phang1, Kenneth Kay Leong Khoo1, Aditya Fahmi Prianda3, Chai Yih Tan1, Kantha Rao Narasamuloo1, Saravanan Krishinan4, Chee Tat Liew5, Dharmaraj Karthikesan6

Sultanah Bahiyah Hospital, Malaysia1, Sultan Idris Shah Serdang Hospital, Malaysia2, Hasna Medika Kuningan Heart Hospital, Indonesia3, Ministry of Health Malaysia, Malaysia4, Pantai Penang Hospital, Malaysia5, Hospital Sultanah Bahiyah, Malaysia6,

Clinical Information

Patient initials or Identifier Number

Relevant Clinical History and Physical Exam

61-year-old gentleman with multiple cardiac risk factors like hypertension, diabetes mellitus, chronic kidney disease and ischemic stroke admitted for Non ST elevation myocardial infarction. Echocardiogram showed preserved left ventricular ejection fraction. He had history of stenting to LAD and RCA in 2016 in different setting. 3 coronary angiograms were done subsequently revealed mild ISR of LAD and RCA stent. He had major depressive disorder due to frequent admission for chest pain. 


Relevant Test Results Prior to Catheterization


Relevant Catheterization Findings




Interventional Management

Procedural Step

Right radial approach with EBU 3.5 engaged to left system. Coronary physiology assessment with µFR was not significant at 0.83 for LAD lesion and 0.90 for RCA lesion. FFR was done revealed insignificant result of 0.83. Proceeded with RFR which was significant of 0.88 at resting and huge step up to 0.95 at ISR LAD segment. LAD wired with Sion Blue. IVUS noted mid to distal stent was undersized without significant plaque. LCX wired with runthrough floppy. Distal lesion predilated with scoring balloon 2.5x15 up to 2.56. Proximal stent predilated with cutting balloon 3.5x10 up to 3.78. Mid to distal stent undersized segment prepared with NC balloon 3.0x15 up to 3.17. IVUS run post preparation noted previous stent expanded well and lesion well prepared. Distal lesion deployed with DEB 2.75x15 up to 2.75. DES 3.5x29 deployed at proximal LAD up to LM. LM POT with balloon 5.0 x8. Proximal stent post dilated with NC balloon 4.0x15 and NC balloon 5.0x10. Post procedure IVUS noted stent well expanded and RFR at resting was 0.93. LVEDP guided hydration was used during procedure as well and total contrast usage was 40cc for this complex PCI.


Case Summary

Coronary physiology assessment, LVEDP guided hydration and IVUS guided PCI has successfully compliment this 6th angiogram of patient and  bring a glimpse of light to this depressed patient. There was no longer complain of angina during the 6 months follow up.