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CASE20200925_015
| High-Risk Intervention (diabetes, heart failure, renal failure, shock, etc) - High-Risk Intervention | |
| PCI in Patient with Non-operable Severe CAD Due to Recent Ischemic Stroke Combined with Severe Bicuspid Aortic Stenosis | |
| Wahyu Aditya1, Muhammad Munawar1, Dian Larasati Munawar1, Dian Setiawan2 | |
| Binawaluya Cardiac Center, Indonesia1, Binawaluya, Indonesia2, | |
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[Clinical Information]
- Patient initials or identifier number:
MR. E.S
-Relevant clinical history and physical exam:
Progessive angina every night
Recent SNH (june2020) Severe AS ec bicuspid valve pro AVR Patient came to our hospital at 5 august 2020 PE :Ejection systolic murmur (+) ECG : SR, inverted T v5-6Echo : EDD 55, ESD 40, EF 53%, TAPSE 1.9 cm LVH eccentric RWMA hypokinetik inferolateral Aorta bicuspid, calcification (+) AVA 0,5cm2, pAVG80mmHg AR mildMR moderateTR mild TVG 50mmHg, PR mild -Relevant test results prior to catheterization:
HB 13.7g/dl,
WBC 8700/uL, ur 47, Cr 1.5, eGFR 42, NT proBNP 5049 - Relevant catheterization findings:
LM : osteal 60% stenosis, distal 60% stenosis, calcified (+)LAD : calcified at proksimal, 70-80% stenosis at proksimal - mid partLCX : calcified (+) at proksimal, subtotal stenosis at mid partRCA: Dominant, subtotal stenosis at mid partCAD3VD + LM
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[Interventional Management]
- Procedural step:
Prepare LCX : Balloon scoreflex 2.5/10IVUS LCX and LADPrepare LAD : Rota bur 1.75 , 5x, 169.000-191. RPM anf Ballon scoreflex 3.5/15DK crushPCI LCX Biofreedom 3.0/36Complete crush LAD B trek 3.5/15recrosingfirst kissing ballon : B trek 3.0/15 (LCX) and B Trek 3.5/15 (LAD)PCI LM-LAD Biofredom 3.5/28 mmPOT LM : B sapphire 5.0/15second recrossingFinal kissing ballon B trek 3.0/15 (LCX) and B Trek 3.5/15 (LAD)
PCI mid LAD resolute integrity 3.0/26 mm RCA : B scoreflex 3.0/15 and PCI DES Resolute integrity 3.5/22 mm   - Case Summary:
Conclusion, PCI mght be the most appropriate choice for elderly CAD combined severe bicuspid aortic stenosis who got recent ischemic stroke. Stents which need shorter dual antiplatelet therapy may be needed due to potential of high bleeding risk and therefore IVUS guided PCI should be performed.
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