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CASE20191114_001
| CORONARY - Acute Coronary Syndromes (STEMI, NSTE-ACS) | |
| Primary PCI in a Post-CABG Case Presenting with Inferior STEMI: What Should Be the Strategy? | |
| Fathima Aaysha Cader1, M Maksumul Haq1 | |
| Ibrahim Cardiac Hospital & Research Institute, Bangladesh1, | |
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[Clinical Information]
- Patient initials or identifier number:
A1
-Relevant clinical history and physical exam:
A 62-year-old diabetic, hypertensive Bangladeshi male presented with chest pain for 1.5 hours. He underwent CABG surgery in 2004, following triple vessel disease. He was haemodynamically stable on admission.
-Relevant test results prior to catheterization:
ECG showed STEMI (inferior). Echo revealed LVEF~45%, inferior and infero-lateral wall hypokinesia.
- Relevant catheterization findings:
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[Interventional Management]
- Procedural step:
In STEMI, ¡°minute means muscle¡±. As RCA was a CTO, we decided to do primary PCI to SVG to RCA, given that a CTO revascularization would be both challenging as well as uncertain in terms of revascularization. Using JR 3.5 6 F guide catheter and Sion Blue wire, the occluded SVG was crossed., revealing significant thrombus burden. Thrombus aspiration was done by Diver C.E. max catheter. SVG to RCA was then stented by 3.5x23 mm DES at 20 ATM. Postdilatation was done by 4.0x10 mm NC balloon (22 ATM). Good distal TIMI III flow was achieved.
 8.avi 12.avi 17.avi- Case Summary:
For this patient, post-PCI DAPT comprised of aspirin and ticagrelor. In the absence of definitive guidelines regarding primary PCI in post-CABG STEMI¡¯s, this case demonstrates the necessity of thrombus aspiration and rapid reperfusion with TIMI III flow in thrombus-laden graft vessel. Ideally, embolic protection devices should be used. The patient must be followed up closely, as SVG¡¯s are notoriously prone to re-stenosis.
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