- 100% subacute thrombosis of distal LAD, moderate, hazy stenosis proximal to occlusion.
- 90% ostial D1 stenosis.
- Non-obstructive disease in remainder of vessels.
- .
- INTERVENTION:
- Successful PCI of distal LAD thrombotic occlusion with POBA, Xience Skypoint 3.0 x 18 mm DES to distal LAD stenosis.
- Successful PCI of Ostial D1 stenosis with Xience Skypoint 2.5 x 15 mm DES.
PROCEDURES PERFORMED:
Coronary angiography
PCI of LAD
PCI of D1
PROCEDURE DETAILS:
The right wrist and and right groin 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.
Next, the RCA was engaged with a 5 Fr JR 4 diagnostic catheter and selective angiography was performed in multiple views.
The JR4 was exchanged over a wire for a 5 Fr JL3.5 diagnostic catheter which was used to perform selective angiography of the left coronary system in multiple views.
An EBU 3.5 was then used to engage the LMCA. A Prowater wire was advanced down the LAD to the very distal vessel. Angioplasty was performed with a 2.5 x 12 mm SC balloon with multiple inflations at the distal/apical vessel up to 8 atm. Next, a Xience Skypoint 3.0 x 18 mm DES was deployed to the distal LAD to 12 atm. The stent was post dilated with a 3.0 x 15 mm NC balloon to 15 atm. Next, a Xience 2.5 x 15 mm DES was deployed to the ostial D1 branch to 12 atm. Repeat angiography showed no residual stenosis and TIMI 3 flow.
At the end of the procedure, a equipment was removed and hemostasis was achieved with a radial band.
FINDINGS:
LMCA - Arises from the left sinus of Valsalva, bifurcates into the LAD and LCX. Angiographically patent.
LAD -moderate to large caliber vessel arising from the LMCA. Gives off two moderate-sized diagonal branches and multiple septal perforators. The distal LAD is 100% occluded due to thrombus. Proximal to the occlusion is a 60% irregular stenosis. There is a 90% ostial diagonal one stenosis. The remainder of the LAD has mild nonobstructive disease and areas of ectasia.
LCX -large caliber vessel arising from the LMCA. Gives off a small OM1 and a moderate to large OM two then tapers in the AV groove. The OM two has a superior and inferior branch, the inferior branch has a 60 to 70% mid vessel stenosis. The remainder of the left circumflex has mild nonobstructive disease.
RCA -large caliber vessel arising from the right sinus of Valsalva. Distally gives off moderate to large PDA and a moderate PLB. Proximal RCA has a 40% stenosis. There are diffuse luminal irregularities throughout the RCA and the PDA.