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.
CASE20191030_001
| IMAGING AND PHYSIOLOGIC LESION ASSESSMENT - Imaging: Intravascular | |
| A ¡°Lotus Root¡± Appearance of Recanalized Coronary Thrombus | |
| Chao-Yu Chen1 | |
| National Cheng Kung University Hospital, Taiwan1, | |
|
[Clinical Information]
- Patient initials or identifier number:
Ms.Tsai
-Relevant clinical history and physical exam:
The 43-year-old female has history of old cerebral infarction, heart failure with reduced ejection fraction, frequent ventricular premature ventricular contraction and left leg deep vein thrombosis. She felt dyspnea on exertion, palpitation and chest tightness intermittently during daily activity although under guideline‐directed medical therapy for heart failure. Physical examination found irregular heart rhythm, bilateral clear breathing sound, but no audible heart murmur or leg edema.
-Relevant test results prior to catheterization:
Holter: Sinus rhythm dominant but frequent PVC with beats within 24 hours. Bigeminy, trigeminy, couplet, and multiform PVC were noted
- Relevant catheterization findings:
Left main coronary artery: Atherosclerosis without significant stenosis
 IVUS(3).wmv IVUS(6).wmv |
|
|
[Interventional Management]
- Procedural step:
We used a SAL1 guiding catheter to engage RCA orifice but we could not wire to distal RCA with Fielder FC wire. The wire went to marginal branch, so we used Sprinter Legend balloon (2.0/20mm) to dilate proximal RCA with 10 bars and then successfully advance wire to distal RCA. After 2.0mm balloon dilatation, we introduce IVUS to RCA. IVUS showed multiple canal with lotus-root appearance of recanalized coronary thrombus. We used an Emerge balloon (4.0/20mm) to dilate proximal to middle RCA with 8 to 12 bars. After 4.0mm balloon dilatation, angiography showed dissection like feature at proximal RCA so we introduced IVUS again. Second IVUS showed those canal was squeezed together and resulted in pseudo-dissection feature. After Energy stent (4.0/35mm) deployment and balloon post-dilatation, final angiography showed good result but loss of marginal branch.
IVUS(56).wmv IVUS(39).wmv IVUS(53).wmv- Case Summary:
Chronic coronary thrombus may result in spontaneous recanalization. Under angiography, it's hard to know detailed structure and it sometimes may be mistaken as spontaneous dissection. OCT is gold standard to diagnosis these situation but IVUS may also provide adequate image. Prevent side branch loss is an difficult issue and try double lumen catheter and make sure wiring to distal main branch as the same canal of side branch before stent deployment is crucial.
|
|
0