1 / 12

Call for CASES

Call for CASES. Stage d PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski , MD Krzysztof Milewski American Heart of Poland, Ustron, Poland & CCU, Upper-Silesian Heart Center Silesian Medical School Katowice, Poland.

mauli
Download Presentation

Call for CASES

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Call for CASES Staged PCI in a patient with multivessel coronary disease disqualified from CABG. Pawel Buszman, MD, FESC, FSCAI Marcin Debinski, MD Krzysztof Milewski American Heart of Poland, Ustron, Poland & CCU, Upper-Silesian Heart Center Silesian Medical School Katowice, Poland

  2. Introduction • PCI and CABG offer similar long term results (in respect to MI and death) in patients with moderately advanced coronary artery disease (CAD). • There are very few information on effectiveness of PCI in patients with diffuse CAD and high risk of surgical intervention. • Technological progress in interventional cardiology together with advances in pharmacology should result in better outcome in patients with end stage coronary artery disease.

  3. Description of the problem • Male,76years old • Unstable Angina, class CCS IV • Medical history: 2xMI (1994-nonQ anterior, 2003-inferior wall) • CAD Risk factors: HA, family history, former smoker • LVEF 40% • EUROSCORE 13 points: • age 4 pt • unstable angina after AMI 2 pt • peripherial atherosclerosis 2 pt • paroxysmal FA 3 pt • chronic obstructive pulmonary disease 1 pt. • respiratory insufficiency 1 pt.

  4. Description of the problem Coronary arteriography: RCA: 60% stenosis in prox. RCA, 99% narrowing in med segment LCA: LM-diam. ca 3.5-4 mm, length 15mm, LAD-30% prox.lesion; critical, long, calcified, tortous lesions in med and distal LAD, Cx-90% type A lesion in prox, 99% type B2 lesion in distal segment. LCA: RAO 30 RCA LAO60 LCA: LAO60/cran25

  5. Intended strategy • Multiple, stage PCI with continous control of previously dilated vessels/segments. • Use of bare metal stents to minimize costs of procedures. • Carefull evaluation of contrast volume used for each procedure and renal function before/after eache stage. • Concomitant pharmacological treatment:ASA 150mg o.d., clopidogrel 75mg o.d.,ACEI, selective beta-blocker, statins,

  6. First stage Aug’2003: Predilatation of critical lesion in med RCA (balloon 3.0x20mm) and stenting of prox/med. segment (stent Chopin, Balton, 3.5x34mm, 18 atm). No complications. Hospitalization 6 days. Right coronary artery (RCA) in LAO 60, before and after PTCA.

  7. Second Stage Sept’2003: RCA: non-significant narrowings in med segments. PCI to Cx: POBA of distal lesion and predilatation and stenting of prox lesion (Chopin 3.0x8mm, 18 atm.) No complications. Hospitalization 3 days. Fig 1. Left coronary artery (LCA) in LAO 60, before and after PCI to Cx.

  8. Third Stage Dec’2003: RCA: patent and large vessel, non-significant narrowing in med segments. Cx: restenosis in distal segment (75%). PCI to LAD: predilatation (balloon 1.5x20 & 2.0x20mm) and stenting of med/distal LAD (Multilink Zeta, 18 atm.). VF during stent implantation, successfully defibrillated within 15 s (1x300W). No further resuscitation or intubation required. PCI to Cx: POBA of distal restenotic lesion (balloon 2.5x20mm), residual stenosis<30%. Lab tests: Troponin I 1.04ng/ml; CK 337 U/l, CKMB 31 U/L. Hospitalization: 4 days.

  9. Third Stage Fig 1. Left coronary artery (LCA) in LAO 60, before and after PCI.

  10. Fourth Stage March’2004: A control angio revealed patent coronary arteries without significant stenosis. RCA: LAO 60 LCA: LAO20/cran25 LCA: RAO 30

  11. Follow-up 9 months after the first stage we noticed: • No significant stenosis in coronary arteries • LVEF improvement (55%) • Decrease of angina symptoms (CCS I) • Improvement in quality of live, NYHA class II • No further intervention requiered. Further intensive pharmacological treatement:statins beta-blocker ACEI ASA

  12. Conclusions • Stage PCI is a rational alternative to CABG in patients with advanced coronary artery disease and high risk of perioperative complications. • In patients undergoing POBA or bare metal stent implantation a routine follow-up angio should be considered. • Stage PCI offers opportunity to review previously dilated/stented coronary segments. It may limit obligatory use of DES.

More Related