Study Result
DATE OF PROCEDURE: 03/08/2018
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INDICATION FOR STUDY: NON-STEMI
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PROCEDURE PERFORMED: LEFT HEART CATHETERIZATION
ABDOMINAL AORTOGRAM
VASCULAR ULTRASOUND OF THE LEFT MAIN
PCI OF THE LEFT MAIN WITH DRUG ELUTING STENT
PCI OF THE DIAGONAL ARTERY WITH A DRUG ELUTING STENT
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CLINICAL SUMMARY: An 81-year-old male with past medical history significant for diabetes mellitus, hypertension, smoking, chronic kidney disease and bladder cancer who was recently admitted to Hospital with non-ST elevation myocardial infarction. *Diagnostic cardiac catheterization revealed severe left main disease. *The patient was transferred to Medical Center for further evaluation and management. *Based on patient’s clinical comorbidities, ST score, severe LV systolic dysfunction, cognitive impairment/dementia the heart team and patient’s family and patient decided to proceed with percutaneous revascularization. *Informed consent obtained.
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PROCEDURE: * The patient was brought to the cath lab in stable condition. *Informed consent was provided after all risks and benefits were explained. *The patient was draped and prepped in usual fashion. 1% lidocaine was administered for local anesthesia. The femoral artery was accessed using micropuncture kit and a 7-French sheath was inserted in the left femoral artery. A*5 Fr sheath was placed in femoral vein. EBU 3.5 catheter was used to perform left coronary artery angiography. * A pigtail catheter was used to performed LV hemodynamics.**The pigtail catheter was also used to perform abdominal aortogram. Femoral angiogram was performed which revealed sheath was suitable for vascular device. Angioseal *vascular closure device was used for arterial hemostasis. *
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FINDINGS:
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Aortic pressure 120/80 mmHg. *
Left ventricular end-diastolic pressure was 14 mmHg. *
There was no significant gradient between left ventricle and aorta.
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CORONARY CINE ANGIOGRAPHY: Coronary circulation is right dominant.
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ABDOMINAL AORTOGRAM: *There is no significant disease in bilateral iliac and femoral arteries.
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LEFT MAIN CORONARY ARTERY: The left main coronary artery has critical calcified/ulcerated 95% to stenosis.
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LEFT ANTERIOR DESCENDING CORONARY ARTERY: Ostial/Proximal 50-70% stenosis. The left anterior descending coronary artery gives off a large diagonal artery. *The diagonal artery has proximal 90% stenosis. *The LAD itself continues as a small to medium caliber vessel with diffuse 40% disease.
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PCI DETAILS: A 7-French, EBU3.5 guide catheter was used to intubate the left main. A short Runthrough wire was used to cross the lesion placed distally into diagonal artery. *A BMW wire was also placed into left circumflex artery. *Predilation of left main lesion was performed with 3.0 noncompliant balloon. *This is followed by deployment of a drug-eluting stent Synergy 2.5 x 24 mm in diagonal 1. *Stent was post dilated with stent balloon. *This is followed by deployment of a drug-eluting stent Synergy 3.5 x 20 mm extending from left main into left anterior descending artery. *This stent was post dilated with 3.5 and 4.0 noncompliant balloon. *Intravascular ultrasound was used for stent size and length. *Intravascular ultrasound revealed well expanded and well opposed stent. *There was no significant plaque shift towards left circumflex artery. *There was no significant stenosis there was no dissection and there was no perforation.*
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IMPRESSION:
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1. Severe left main disease which was treated with single drug-eluting stent (provisional stent technique) under intravascular ultrasound guidance.
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2. Severe diagonal disease which was treated with single drug-eluting stent.*
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RECOMMENDATIONS: *
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1. Dual antiplatelet therapy.
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2. Aggressive medical therapy and risk factor modification.
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PAST MEDICAL HISTORY
He has a past medical history of Anxiety; Bladder cancer; Chronic kidney disease (CKD), stage III (moderate); Depression; Diabetes; Hyperlipidemia; Hypertension; Nephrolithiasis; Prostate cancer; Restless leg; and SVT (supraventricular tachycardia). He has a past surgical history that includes hx hernia repair (Bilateral); hx knee replacement (Right); and tonsillectomy.