Lots of interesting abstracts and cases were submitted for TCTAP 2025. 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-009
ACS - Circumflex and LM Critical Disease and Double CTO in a Young Patient With Haemophilia and Poor LVEF
By Chi Kit Yu
Presenter
Chi Kit Yu
Authors
Chi Kit Yu1
Affiliation
Tuen Mun Hospital, Hong Kong, China1,
View Study Report
TCTAP C-009
Coronary - ACS/AMI
ACS - Circumflex and LM Critical Disease and Double CTO in a Young Patient With Haemophilia and Poor LVEF
Chi Kit Yu1
Tuen Mun Hospital, Hong Kong, China1,
Clinical Information
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
The patient is a 42 years old gentlemen with history of HIV and haemophilia. He had no family history of cardiovascular disease and he had no history of diabetes and hyperlipidemia. He presented to emergency department with chest pain for 2 days and also an episode of loss of consciousness before admission.
Relevant Test Results Prior to Catheterization
ECG showed ST depression in inferior and V4-V6 leads. Echo showed global hypokinesia with a LVEF of 19.4%, mild MR/TR only.
Relevant Catheterization Findings
Coromild LM critical stenosis
pLAD CTO
LCx diffuse disease max 99% stenosis
RCA p-mRCA severe stenosis with dRCA CTO
pLAD CTO
LCx diffuse disease max 99% stenosis
RCA p-mRCA severe stenosis with dRCA CTO
Interventional Management
Procedural Step
CABG turned down by CTS surgeonPatient had lowish BP while on dopamine when transferred to cath lab
We placed Impella CP before PCI and proceed to PCI to o-dRCA with DES x 4, another DES at dRCA-PL with overlapping of previous stent
Then we proceed to LM bifurcation with mini-crush technique with DES x 3
Subsequently we proceed to LAD CTO and successfully wired by GAIA Next 3
Stent LAD with 2 DES stent and overlap with LM-pLAD stent
Noted closure of septal branch and attempted rewiring of septal branch by Fielder XT-A via Crusade
Finally DES x 5 was implanted via minicrush technique
Patient able to wean Impella in cath lab and was discharged subsequently
We placed Impella CP before PCI and proceed to PCI to o-dRCA with DES x 4, another DES at dRCA-PL with overlapping of previous stent
Then we proceed to LM bifurcation with mini-crush technique with DES x 3
Subsequently we proceed to LAD CTO and successfully wired by GAIA Next 3
Stent LAD with 2 DES stent and overlap with LM-pLAD stent
Noted closure of septal branch and attempted rewiring of septal branch by Fielder XT-A via Crusade
Finally DES x 5 was implanted via minicrush technique
Patient able to wean Impella in cath lab and was discharged subsequently
Case Summary
In conclusion, this case demonstrates three very important messages. Firstly, in critical LM and TVD, although guideline suggest CABG but in some setting, CABG may not be readily available, PCI can be a good alternative. Secondly, in patient with complex coronary anatomy & poor EF, Impella CP is essential. Thirdly, this case demonstrated in frustrated situation when CABG was turned down but with endurance and courage, we could successfully overcome with difficulties with good results.