Procedures
| Coronary angiography |
| Bypass graft study |
| Peripheral angiography |
| Stent DES bypass graft |
| Percutaneous coronary intervention |
Pre Procedure Diagnosis
| Post Procedure Diagnosis
|
Indications
| NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC) [I21.4 (ICD-10-CM)] |
Conclusion
• Occluded distal LMCA, patent LIMA to LAD and Diagonal branch, occluded SVG to OM/LCx.
• Proximally occluded RCA, SVG to RPL with two sequential high grade stenoses and a 99% proximal RPL stenosis.
• Mild stenosis of proximal left subclavian artery
• .
• INTERVENTION:
• Successful PCI of distal SVG with Xience Skypoint 4.0 x 15 mm DES, post-dilated with a 4.0 x 8 mm NC balloon to 18 atm..
• Successful PCI of proximal RPL with a Xience Skypoint 2.5 x 15 mm DES, post dilated with a 4.0 x 8 mm NC balloon to 18 atm.
• .
• PLAN:
• DAPT and statin.
PROCEDURE:
The bilateral groin areas were prepped and draped in a sterile manner.
The soft tissue above the right wrist was locally anesthetized with 1% lidocaine solution.
The right radial artery was accessed with a 20 gauge angiocatheter needle using the through-and-through technique and 5 Fr Glidesheath was placed.
A JR4 diagnostic catheter ws used to engage the RCA, SVG to OM and LIMA graft to perform angiography. Next a Pigtail catheter was used to perform angiography of the left subclavian artery given difficulty advancing catheters through the subclavian and presence of LIMA graft to LAD and diagonal branch. Next an RCB catheter was used to engage the SVG to RPL and perform angiography. A JL3.5 catheter was used to engage the LMCA and perform angiography. Next an RPL guide was used to engage the SVG to RPL. A whisper wire was advanced down the SVG beyond the lesions and into the RPL branch. A 2.0 x 15 mm SC balloon was used to perform angioplasty on the RPL lesion and the distal SVG lesions to 14 atm. The distal SVG lesions were then ballooned with a 3.0 x 12 mm SC Balloon to 14 atm. A Xience Skypoint 4.0 x 15 mm DES was then deployed to the distal SVG to 16 atm. A Xience Skypoint 2.5 x 15 mm DES was then deployed to the RPL proximal lesion to 16 atm. The RPL stent was post dilated with a 3.0 x 12 mm NC balloon to 18 atm and the SVG stent with a 4.0 x 8 mm NC balloon to 18 atm.
At the end of the procedure, a equipment was removed and hemostasis was achieved with an angioseal device.
FINDINGS:
LMCA - Arises from the left sinus of Valsalva. Occluded distally.
LAD - occluded ostially.
LIMA to LAD and diagonal branch (sequential) is angiographically patent.
LCX - Occluded
SVG to OM/LCX - occluded.
RCA - occluded proximally. 99% RPL stenosis.
SVG to RPL has 2 sequential high grade distal stenoses