Lots of interesting abstracts and cases were submitted for TCTAP & AP VALVES 2020 Virtual. Below are accepted ones after thoroughly reviewed by our official reviewers. Don¡¯t miss the opportunity to explore your knowledge and interact with authors as well as virtual participants by sharing your opinion!
* The E-Science Station is well-optimized for PC.
We highly recommend you use a desktop computer or laptop to browse E-posters.
CASE20191015_001
| CORONARY - Bifurcation/Left Main Diseases and Intervention | |
| Trifurcation in Left Main Disease: Optimal Revascularization with Sequential DK Crushed Technique | |
| Dian Larasati Munawar1, Muhammad Munawar1, Gunawan Yoga1, Kabul Priyantoro2 | |
| Binawaluya Cardiac Center, Indonesia1, RSUD Kota Bekasi, Indonesia2, | |
|
[Clinical Information]
- Patient initials or identifier number:
Mr YT
-Relevant clinical history and physical exam:
A 53-year-olddiabetic, non-smoker male patient presented with Canadian CardiovascularSociety (CCS) class II angina but increase in intensity within couples ofweeks. His baseline ECG was normal. No increase of cardiac enzyme. He had anexperience of 1 stent implantation at proximal left circumflex in three yearsbefore. Hewas on single antiplatelet therapy and statin therapy. No history of myocardialinfarction
-Relevant test results prior to catheterization:
Hewas on oral diabetic medication and his Hb1C was 7.1%. . Histreadmill test was 3¡¯ 04¡± and positive ischemic respons. He felt chest discomfort durin treadmill. His echocardiography was good, with normal ejection fraction. His laboratory result was within normal limit.
 - Relevant catheterization findings:
Coronaryangiography done and revealed the left coronary artery showed critical stenosisat the distal LM. The left anterior descending artery (LAD) and left circumflexartery (LCX) were nearly equal in vessel size with very critical stenosis inand ostial portions, and the ramus intermedius had a 75-80%% ostial stenosis. Therewas instent stenosis at the proximal LCX. The trifurcation lesion was classifiedas a Medina 1,1,1,1 lesion.
 MOVIE-0001.wmv MOVIE-0002.wmv MOVIE-0003.wmv |
|
|
[Interventional Management]
- Procedural step:
Intraaortic balloon pump was inserted.Rotablator with 1.75 mm burr (BostonScientific) was performed for debulking to prevent shifting plaque. Threefloppy wires were inserted into distal LAD, ramus intermedius and LCX.Predilation was done in LAD and ramus intermedius using scoring balloon tokeep the branches open. A 3x18 mm DES was inserted at the proximal LCX andlitle protrude into main vessel (MV). The stent was then crushed using 3.5balloon (complete crush). Recrossing with the fresh wire at the proximal strutand followed by first kissing balloon with 3x15 mm and 3.5x15 mm at the LM-LCXand LM LAD. Two DES (2.5x 18 mm and 3.0x18 mm at the distal and proximalrespectively) overlapped was inserted at the ramus intermedius. The completecrush and first kissing balloon was repeatedly done at the ramus intermedius.Then 3,5x38 mm DES was inserted from the proximal LM to LAD. POT was done atthe bifurcation of LAD and ramus using 4x12 mm NC balloon and at thebifurcation of LM-LAD and LM-LCX using 4.5x12 mm NC balloon. Recrossing to thestrut of the ramus intermedius was done at the mid area, followed by secondkissing balloon using 3.0x15 mm and 3.5x15 mm at the ramus intermedius-LAD and LAD. The procedure was repeated at theLCX. Recrossing to the strut to the LCX at the mid area), then followed bysecond kissing balloon using 3x15 mm and 4x14 mm at the LCX-LM and LAD-LM. wedo not do triple balloon inflation. Nine months follow up angiography showed good result.
for TCTAP.mp4 for TCTAP final result.mp4 9 months FU.mp4- Case Summary:
LM Trifurcation disease with medina 1-1-1-1 is complex and challenging case. Debulking using rotablation atherectomy and scoring balloon can prevent shifting plaque in bifurcation lesion. Sequential DK Crush in LM Trifurcation is safe and effective option in managing critical stenosis trifurcation LM medina 1-1-1-1. In intermediate follow up there was a significant improvement in physical capacity. Angiogram evaluation after 9 months showed good result.
|
|
0