Discussion point 1 Stenting or no stenting? Discussion point 2 - PDF document

A 42 years old lady presenting an acute anterior STEMI, no bleeding risk Case # 4 proposed by Pr Pasi Karjalainen, Pori, Finland Hexacath Case in Point Session EuroPCR 2016 Room 351 – Thursday 19 th - 12:30-14:00 Clinical Presentation: In October 11 th 2009, a 42-year-old smoker lady presented to the emergency room complaining of severe ischemic-type chest pain for less than an hour, which persisted despite receiving aspirin (chewing) and nitrates (spray) in the ambulance. She reported a similar episode of chest pain the night before that awaken her from sleep and lasted for 20 minutes, and a sense of chest discomfort the evening before. Recently, she also reported feeling upper abdominal pain for which she received some medication. Examination: The patient was in a rather good general condition, slightly sweaty, with warm extremities. Pulse rate was 50-60 bpm, regular, well-felt peripherally. Blood pressure was 135/90 mm Hg. Chest and heart auscultation was uneventful. Abdominal examination revealed no abnormality. ECG revealed sinus rhythm, 1-2 mm elevation of the ST segment in leads V 2 through V 5 , I and aVL, with ST segment depression in the inferior leads. Bedside echocardiography revealed apical anterior wall akinesia, ejection fraction 50% by Simpson´s method, left ventricular hypertrophy. Management: The patient was triaged to the cath lab, and immediately prepared to undergo primary percutaneous coronary intervention. The patient received clopidogrel (600 mg), and intravenous bivalirudin. Coronary angiography revealed totally occluded mid segment of the 1

LAD with TIMI grade 0 forward flow, no significant stenosis in the LCx. The RCA was smooth- walled with normal flow. The vessel opened after the guide wire crossed the occlusion, adequate flow was established, and chest pain disappeared. Thromboaspiration was performed. After intracoronary injection of nitroglycerin and adenosine, stenosis was still angiographically significant. Discussion point 1 Stenting or no stenting? Discussion point 2 What stent technology? Optical coherence tomography was performed, revealed that thrombi were still present all through the artery, but failed to detect the site of plaque rupture. 2

Same question: Stenting or no stenting? Come & discuss this clinical case during the Hexacath Case in Point Session at EuroPCR 2016 Room 351 Thursday 19 th 12:30-14:00 3