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One stage coronary and peripheral intervention

One stage coronary and peripheral intervention. P. Eugeniusz Buszman, MD American Heart of Poland Ustron, Poland. Case report. Clinical data Male, 72 year old Unstable angina (CCS class 4) TIAs RISK FACTORS: -heavy smoker (30 cigarettes a day) -hypercholesterolemia. Case report.

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One stage coronary and peripheral intervention

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  1. One stage coronary and peripheral intervention P. Eugeniusz Buszman, MD American Heart of Poland Ustron, Poland

  2. Case report Clinical data • Male, 72 year old • Unstable angina (CCS class 4) • TIAs • RISK FACTORS:-heavy smoker(30 cigarettes a day)-hypercholesterolemia

  3. Case report • EKG:ST depressions in inferior leads • UKG:normal LV function

  4. Coronary and peripheral angiography ICA 99% CCA AP: aortic bifurcation and iliac arteries LAO30: left CCA and ICA

  5. Coronary and peripheral angiography LM: 80% stenosis 90% LCA: RAO30 RCA: RAO30

  6. Strategy of the procedure • Predilatation and stenting of mid. RCA • Direct stenting of LM • Predilatation and stenting of left ICA • Kissing stenting of aortic bifurcation

  7. PTCA: RCA stenting 6F guiding catheter Predilatation: balloon 2.5 mm Stent: Bx Velocity 3.0x18mm Max pressure 14 atm. RCA after stenting

  8. PTCA: LM-stenting Guiding Catheter JL6F Wire: BMW 0,014” Stent: BX Velocity 3.5x18mm Max. pressure 20 atm

  9. Carotid stenting Long Sheath 7F Wire: BMW 0,014” Pre-dilatation: balloon 3.5 mm Stent: SMART 7x20mm Post-dilatation: balloon 4.5 mm

  10. Kissing stenting of aortic bifurcation Bilateral, retrograde approche through 7F sheats. Direct stenting: 2xWallstent 10x45mm Postdilatation:balloons 2x8.0mm

  11. Procedure protocol • No of guiding catheters: 2 • No of balloons 4 • No stents 5 • No of wires: 2 • No of arterial sheats 4 • Contrast volume 350 ml (non-ionic) • X-ray exposition 19,5 min. • Procedure time 110 min.

  12. Periprocedural outcome and long-term follow-up • No procedure related complications • 48 hour hospital stay • Normal renal function • No recurrence of myocardial ischemia or TIA during 6 month follow-up • Normal daily activity

  13. 6 month control coronary angiography: Stented segment LCA: RAO30

  14. Discussion • Why one-stage procedure? • Unstable angina requiring myocardial revascularization • High risk surgical candidate • Critical ICA narrowing with TIAs • Risk of the inferior limb ischemia after the arterial sheath removal • Repeat access to heart to be maintained!

  15. The substantial risk of:-AMI-sudden cardiac death-stroke-critical limb ischemia-surgical treatment -cardiac surgery -vascular surgery The risk of-LM stenting&restenosis-carotid stenting-renal failure-in-stent restenosis Why a percutaneous procedure?The patient’s risk summary Pro Contra

  16. Risk of stroke • In symptomatic patients with severe narrowing of a common or internal carotid artery annual risk of stroke range between 20-30%

  17. Coincidence of CAD and PAD • 30-50% of patients with PAD have coronary artery disease

  18. Major cardiovascular events in patients with PAD – 5 year follow-up • AMI, UA, Stroke 20% • Death 20-30% (PAD Detection, Awareness, Treatment and Primary care.JAMA 2001;286:1317-1324.)

  19. Influence of PAD on long-term survival PAD Detection, Awareness, Treatment and Primary care. JAMA 2001;286:1317-1324.

  20. Prognosis in patients with severe PAD one-year mortality rate • Critical inferior limb ischemia 25% • An inferior limbamputation 45%

  21. Conclusions • Long term survival after myocardial revascularisation can be limited by severe carotid and peripheral artery disease. • Cardiac cath lab should be prepared for a peripheral intervention. • Interventional cardiologists should be routinely trained in those procedures.

  22. Conclusions • Drug eluting stents should enhance the safety of LM stenting.

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