Case Review Katrine Zhiroff, MD USC Keck School of Medicine Los Angeles, CA
Disclosures: ▪ Biotronik (consulting) ▪ Terumo (consulting) ▪ Abiomed (consulting) ▪ Novartis (speakers’ bureau)
Clinical Cases • Deliverability • Pushability • Side Branch Access
Case • 67 year old woman with long-standing hypertension • Presents with crescendo angina x 2 months, now with <1/2 block • Unstable angina with rest pain relieved by NTG gtt • ECG: sinus rhythm with dynamic T wave inversions in II, III, aVF, V3-6 • Echo: EF 70%, LVH, no wall motion abnormalities • Home Medications: HCTZ, amlodipine • Labs • Creat 0.86, TnI<0.01 • Total Chol 211, TG 172, LDL 139, HDL 38
• Right radial artery 6Fr Slender • 6 Fr JL 3.5 guide • FFR of ostial LAD 0.79 • PTCA with 3.0x12 mm Emerge
4.0x16 mm Orsiro stent
IVUS: good expansion and Post dilated with 4.0 mmx12 mm Emerge NC apposition of stent in ostial LAD
Resting FFR 0.8 across mid LAD
Predilated with 3.0x12 mm Emerge
Orsiro 3.5x24 mm
Overlapping distal Orsiro 3.5x13 mm
Case • 72 yo man with history of CAD, ischemic cardiomyopathy, ongoing tobacco abuse, chronic kidney disease (Cr 1.5) • Ischemic CM, EF 35% • 4v CABG and bioprosthetic valve replacement 1990s in Philippines • LIMA to LAD, SVG to D1, SVG to OM1 sequential OM2, SVG to RCA (100%) • h/o CHB, s/p PPM • Prior PCI of ostial RCA (Xience) and OM (Absorb) in 2016 • Presented with unstable angina at OH in Guam • Attempted PCI of LCx, however, unable to deliver equipment • Presents for elective revascularization • Currently angina with ADLs
• Right radial artery access • 6 Fr Slender sheath • 6 Fr Q4 Guide catheter • 0.014” Whisper Extra Support
• 0.014” PT2 Moderate Support • Emerge 2x12 mm PTCA
Emerge 2x12 mm PTCA
• IC Adenosine (2x 25 mcg)
Orsiro 2.75 x 13 mm Post dilation with 2.75x8 mm Emerge NC
Orsiro 2.75x15 mm Post dilated with 2.75x12 mm Emerge NC
Orsiro 2.75x30 mm
Case: Courtesy of Dr. Juan F. Iglesias MD FESC Geneva University Hospital, Switzerland • 71 yo male patient, former pilot of the UK Royal Air Force • Risk factors: hypertension, dyslipidemia • No relevant past medical history • Current presentation: 1 hour ongoing typical central chest pain, shortness of breath • ECG: anterior STEMI • Transferred to catheterization laboratory for primary PCI • Haemodynamical instability, cardiogenic shock, extreme agitation • Oro-tracheal intubation, pharmacological resuscitation
Manual aspiration thrombectomy
VF arrest , CPR Pantera Leo 3x15mm @ 14 atm
IABP Insertion
Orsiro 3x15mm @12 atm in mid LAD Orsiro 4.0x22mm @ 12 Atm LM-prox LAD
Pantera Leo 4x12mm @ 18 Atm LM-LAD Orsiro 3.5x22 mm @ 14 atm LCx
Orsiro 2.75x25mm @ 14 atm LCX
Final Kissing Ballon LAD-LCx with Pantera Leo 4x12 LAD and 3.0x12 LCx @ 14 Atm
Final angiographic result
Case: Courtesy of Dr. Juan F. Iglesias MD FESC Geneva University Hospital, Switzerland • 64 yo male patient. • Risk factors: hypertension, dyslipidaemia, ex-smoker. • Past medical history: • GOLD stage 2 COPD • PAD • CAD with prior PCI to RCA (1 DES) 3 years ago. • Current presentation: 2-month history of typical exertional angina and new-onset shortness of breath on exertion. • Cardiac MRI: preserved LV systolic function, antero-septal, anterior and anterolateral walls reversible myocardial ischaemia, no myocardial infarction. • Medication: Aspirin, Irbesartan, Metoprolol, Atorvastatin.
PANTERA PRO 2.0 x 15 mm @ 12 atm (D1)
EBU 3.75 6Fr Guiding catheter Sion Blue and Sion Blue extra support guidewires (buddy wire technique) Xience 2.25 X 8 mm Orsiro 2.25 X 9 mm
ORSIRO 2.25 x 9 mm @ 12 atm (D1)
Orsiro 3.0 X 35 Mm (Proximal To Mid Lad) Kissing Balloon Lad-D1 Pantera Lux DEB 2.0 X 20 Mm (D2)
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