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Management of LCA-LM dissection.

Management of LCA-LM dissection. Bogdan Gorycki American Heart of Poland Ustron, Poland. Case report. 42 years old female Effort angina, diseaness, syncope Hypertension Diabetes mellitus Hypothyreosis Overweigth (body weight 120 kg). Non-invasive tests. UKG: LV function normal

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Management of LCA-LM dissection.

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  1. Management of LCA-LM dissection. Bogdan Gorycki American Heart of Poland Ustron, Poland

  2. Case report • 42 years old female • Effort angina, diseaness, syncope • Hypertension • Diabetes mellitus • Hypothyreosis • Overweigth (body weight 120 kg)

  3. Non-invasive tests • UKG: LV function normal • EKG: ST/T changes at rest • Spiral CT: hypoplasia of left vertebral artery, no significant lesion in carotid arteries, right vertebral artery ostial lesion.

  4. Further diagnosis • The patient scheduled for coronary artery and carotid/vertebral angiogragphy

  5. LCA: RAO30, Caudal 15

  6. LCA: LAO 55, Cranial 22 Dissection LM/Cx Time: 22:50 Dissection LAD/D1

  7. Fast diagnosis and problem solving • Diagnosis:Spiral dissection of LM, LM bifurcation, proximal Cx and proximal LAD/D1 • Management:-stop diagnostic procedure-immediate proceeding to LM stenting: -6F JL Guiding catheter -two soft wires (BMW, Guidant)

  8. Fast wiring of LAD and Cx Time: 22:55 Aortic pressure:90/50 mmHg HR: 110/minECG: ST elevation. Chest pain treated with analgetics.

  9. Direct stenting LM/LAD Time: 23:00 Time: 22:57 Aortic pressure:80/40 mmHg HR:120/min. Aortic pressure: 100/60 mmHg HR 90/min. After LM/LAD stenting BX Velocity 3.5x23mm18 atm., 15 sec.

  10. Cx stenting Stent Bx Sonic 3.5x13mm in position. Re-wiring Cx wire and predilatation Ostium Cx with2.5 balloon

  11. Final result: Time: 23:16 LCA:RAO30, Caud22 LCA: LAO52, Caud 14

  12. One-stage VA stenting: Direct stenting: BX Velocity 4.0x13mm Ostial stenosis (90%) of right VA artery

  13. Conclusions • LM stenting is life saving procedure in patients with LM dissection which occurs during diagnostic or therapeutic percutaneous coronary intervention. • The procedure should be included to routine training and practice.

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