1 / 13

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

wallace-maynard
Download Presentation

Management of LCA-LM dissection.

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. 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.

More Related