|Percutaneous coronary intervention|
Pre Procedure Diagnosis
Post Procedure Diagnosis
|STEMI (ST elevation myocardial infarction) (CMS/HCC) [I21.3 (ICD-10-CM)]|
- 60% proximal RCA stenosis, 80-90% mid RCA in-stent restenosis and a hazy lesion in the the proximal RPDA.
- 40% mid LAD after D2, a subtotal occlusion apical LAD, remainder of the vessel has diffuse, mild-moderate luminal irregularities.
- LCx with mild luminal irregularities.
- Successful PCI of proximal-mid RCA with Xience Skypoint 3.5 x 12 mm and 3.0 x 32 mm overlapping DES, post dilated with a 3.5 x 12 mm NC balloon to 20 atm.
- Successful PCI of proximal RPDA with Resolute Onyx 2.0 x 15 mm DES to 16 atm.
- Admit for post STEMI care
- DAPT and statin.
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 6 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 did not reach the LMCA, therefore, a JL4 was used to perform selective angiography of the left coronary system in multiple views.
The JL4 was exchanged over a wire for a 6 Fr JR4 guide catheter, which was used to engage the RCA. A Prowater wire was advanced down the RCA into the PDA. Angioplasty of the proximal-mid RCA was performed with a 3.0 x 12 mm SC balloon up to 16 atm. Next, a Xience Skypoint 3.0 x 32 mm DES was deployed to 12 atm to the proximal-mid RCA. A second Xience 3.5 x 12 mm DES was deployed to the proximal edge of the other stent to 12 atm. Both stents were post dilated with a 3.5 x 15 mm NC balloon to 20 atm. Next, a Resolute Onxy 2.0 x 15 mm DES was deployed to 16 atm the proximal RPDA.
At the end of the procedure, a equipment was removed and hemostasis was achieved with a radial band.
LMCA - Arises from the left sinus of Valsalva, bifurcates into the LAD and LCX. Mild luminal irregularities.
LAD - Arises from the LMCA, gives off a small branching diagonal 1, a moderate caliber, branching diagonal 2, multiple septal perforating branches then wraps around the apex. There is a 40% mid LAD stenosis just after the D2 take-off, a subtotal occlusion of the LAD at the apex and the remainder of the vessel has diffuse, mild-moderate luminal irregularities.
LCX - Arises from the LMCA, gives off a moderate OM1 and a small OM2. There are mild luminal irregularities in the LCx and its branches.
RCA - Arises from the right sinus of Valsalva, gives off a small-moderate PDA and PLB. There is as 60% proximal RCA stenosis, 80-90% mid RCA in-stent restenosis and a hazy lesion in the the proximal RPDA.