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-035
OCT Guided Deferred Stenting Primary PCI of Ectatic LAD With Heavy Thrombus Burden
By Kala Jeethender Kumar
Presenter
Kala Jeethender Kumar
Authors
Kala Jeethender Kumar1
Affiliation
Yashoda Hospitals Hi-Tech City, India1,
View Study Report
TCTAP C-035
Coronary - Adjunctive Procedures (Thrombectomy, Atherectomy, Special Balloons)
OCT Guided Deferred Stenting Primary PCI of Ectatic LAD With Heavy Thrombus Burden
Kala Jeethender Kumar1
Yashoda Hospitals Hi-Tech City, India1,
Clinical Information
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
40 years old male presented with chest pain associated with shortness of breath. CAD-anterior wall MI (WP>24hrs). On Examination-PR-60/min, BP-140/80mmHg, RR-22/min, SPO2-99%, CVS-S1+, S2+, P/A-Soft BS+, RS-Bilateral air entry adequate, CNS-No focal neurological deficit. Investigations-Hb-12.80g/dl, Serum creatinine-0839mg/dl, RBS-179mg/dl, TROP I-24.20ng/ml.
Relevant Test Results Prior to Catheterization
ECG showed anterior wall myocardial infarction, 2D Echo showed RWMA+ in LAD territory, moderate LV dysfunction with EF-45%.
Relevant Catheterization Findings
CAG revealed LMCA-Normal, LAD-Proximal cut off with thrombus, LCX-Normal (Ectatic), RCA- Normal (Ectatic).
Interventional Management
Procedural Step
Procedure performed through right radial artery LMCA engaged with 7Fr EBU 3.5 Guiding catheter, Lesion crossed with pilot 50 guide wire. Then Thrombus done with 6Fr Thrombuster II. Predilatation done with 3.0x10mm Balloon. Inj Nikoran and Tirofiban given. As they was significant thrombus burden after thrombus aspiration, defferd stenting strategy was planned. PCI to LADProcedure performed through right Femoral artery LMCA engaged with 6Fr EBU 3.5 Guiding catheter, Lesion crossed with Run through guide wire. Pre OCT showed spontaneous coronary artery dissection in proximal LAD with thrombus with distal segment is 2.36sqmm. LAD stenting done with 3.5x16mm synergy megatron DES. Post OCT showed Mal apposition then dilated with 6.0x8mm NC Balloon. Final OCT study showed well apposed stent struts with distal segment 8.03sqmm, proximal 16.99sqmm. The final result was good with TIMI III Flow. Patient was discharged in a stable status on 3rd post procedure day without any CV Symptoms.
Case Summary
OCT help in assess thrombus burden and other features of atherosclerotic plaque in coronary artery ectasia. A large thrombus burden can make it difficult to size the stent and position it properly, which can increase the risk of stent thrombosis. Aspiration thrombectomy is very useful in cases of large thrombus burden. OCT guided PCI has been shown to be associated with better clinical outcomes than angiography guided PCI.