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CASE20191115_009
| CORONARY - Complications | |
| Poor Sizing of Stent Leading Stent Thrombosis and Consequences | |
| Samir Gautam1 | |
| Gautam Buddha Community Heart Hospital, Nepal1, | |
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[Clinical Information]
- Patient initials or identifier number:
46 years old gentleman
-Relevant clinical history and physical exam:
He presented with central chest pain of 8 hours duration. Associated with diaphoresis.BP 90/60 mmHg. Pulse 94/min.ECG showed ST segment elevation anterior precordial leads.Echocardiography showing hypokinesia of LAD territory with ejection fraction 40%.RFT normal.Cardiac biomarkers positive.
 DENA NATH PANTHI 40Y-M_(S4_F1-42).avi DENA NATH PANTHI 40Y-M_(S6_F1-33).avi-Relevant test results prior to catheterization:
His coronary angiogrpahy result was SVD LAD total occlusion from mid part.Planned for coronary Angioplasty.
PANTHI 46Yrs_DINA NATH_(S19_F1-29).avi PANTHI 46Yrs_DINA NATH_(S23_F1-37).avi- Relevant catheterization findings:
He was discharged with clinical improvement.But again presented on 4th day of discharge with severe chest pain 4 hours duration, diaphoresis, restlessness.He was in shock, BP 70/40 mmHg. Pulse 120/min.Planned for CAG.There was stent thrombosis.PCI with stenting done using three stents.He improved clinically.Discharged D3.Clopidogrel changed to Prasugrel.Completed 1 year follow up.Doing fine.
PANTHI 46Yrs_DINANATH_(S2_F1-46).avi PANTHI 46Yrs_DINANATH_(S21_F1-47).avi PANTHI 46Yrs_DINANATH_(S52_F1-38).avi |
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[Interventional Management]
- Procedural step:
After coronary angiography coronary angioplasty was planned. wiring of lesion done with BMW PTCA guidewire. Balloon dilatation of lesion done with 2,15 and 2.5, 15 NC balloon catheters. Some distal flow was established. Thrombosuction was done. After getting satisfactory distal flow, stenting was planned. Stenting done with three stents. stents deployed first in distal part, then mid part and finally at proximal part. Post dilatation was done at overlapping segments with NC balloon catheter. Acceptable distal flow was established. Patient shifted to CCU for further care.
PANTHI 46Yrs_DINANATH_(S25_F1-48).avi PANTHI 46Yrs_DINANATH_(S52_F1-38).avi- Case Summary:
Patient initially presented with acute myocardial infarction and received PCI. But the choice of stent was not appropriate for size of vessel and length of the lesion so he presented with subacute stent thrombosis. This was managed well. Patient survived. Patient is on follow up. He completed one year follow up.
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