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Complex coronary interventions will be performed in Kantonsspital, St Gallen (Switzerland) by Dr Daniel Weilenmann.
Around an interactive discussion with Dr Stéphane Rinfret from Montreal (Canada), both Experts will review these video cases in a step-by-step approach, observing the chosen strategy depending on patients datas and indications, analysing the devices selection, commenting the management of complications, and concluding with the quality of results.

 

Program

13:00 Introduction
13:05 Case in box n°1: Complex PCI in MVD (Rotablator)
Panel Discussion
13:25 Case in box n°2: CTO of mid RCA
Panel Discussion
13:45 Case in box n°3: LAD PCI with a self apposing stent
Panel Discussion
14:05 Case in box n°4: In stent CTO post CTO PCI mid RCA
Panel Discussion
14:25 Take home messages

Cases in box: Clinical Data

  • Case in box n°1: Complex PCI in MVD (Rotablator)
    • Male, 78 years old
    • No CAD known
    • Since 3 weeks angina pectoris CCS II
    • No concomitant diseases known
    • CVRF: hypertension, dyslipidemia
    • 11.9.17 admitted for NSTEMI with intermittent angina
    • CAG 11.9.17: very calcified vessels, proximal LAD 50.70%, eccentric, mid LAD 95% (culprit lesion), CX proximal 50%, marginal 80%, RCA with severe stenosis ostial stenosis, mid RCA with severe stenosis
    • Echo: normal, LVEF 65%; mild aortic stenosis
    • Renal function: eGFR = 55 ml/min/1.73m2


       
  • Case in box n°2: CTO of mid RCA
    • Male, 62 years old
    • No CAD known
    • Check up showed a pathologic ECG, asymptomatic
    • Cardiologist found a slight inferior hypokinesia
    • Stresstest: significant ST depression, no angina
    • No concomitant diseases known
    • CVRF: smoker (70py), hypertension, dyslipidemia, family history
    • Sent for CAG
    • CAG 24.8.17:proximal LAD 50%, D1 and D2 50%, CX without stenosis, dominant with occlusion of the mid part
    • J-CTO score: 1


       
  • Case in box n°3: LAD PCI with a self apposing stent
    • Male, 44 years old
    • No CAD known
    • Since 3 weeks angina, in the last days clas IIII
    • T-inversions in the V1-V6
    • Echo: normal LVEF 65%, inor regional dysfunction
    • CVRF: family history, dyslipidemia, former smoker
    • Renal function: eGFR =>90 ml/min/1.73m2
    • CAG: tight stenosis of the proximal LAD, intermediate stenosis of mid LAD, intermediate stenosis of the CX

  • Case in box n°4: In stent CTO post CTO PCI mid RCA
    • Male, 54 years old
    • 2005 CTO PCI of the RCA with DES
    • 2011 CTO PCI of the LAD with DES
    • Asymptomatic for several years
    • No concomitant diseases known
    • CVRF: former smoker (10py), hypertension, dyslipidemia, IDDM
    • Echo: LVEF 65%, normal
    • MRI: Normal LVEF, full viability, large inferior ischemia
    • Renal function: eGFR = 93 ml/min/1.73m2
    • Since 3 months angina pectoris CCS II
    • SPECT with inferior ischemia. Sent for CAG
    • CAG 5.9.17: LAD 50% with good result in DES, CX without stenosis, in-stent reocclusion of the RCA
    • J-CTO score: 1

Educational objectives

  • Improve coronary angioplasty knowledge (techniques and approach strategies).
  • Discuss the choice of a material.
  • How to manage complications.
  • Compare techniques and approach strategies of different experts.

Audience

  • This web symposium is dedicated to interventional cardiologists interested and/or specialized in coronary angioplasty.
  • A prerequisite for attendees in an initial knowledge and practice of angioplasty.

 

Shooting date : 2017-09-14
Last update : 2018-08-03
Daniel Weilenmann
St. Gallen, Switzerland
Stéphane Rinfret
Atlanta, United States
5 comments
Join the Discussion
See previous comments (1)
  • Lorenzo A. Hi guys. Do you usually perform IVUS after Rotablator, to assess for the need for additional plaque modification, or on the contrary to decide if a DEB is enough?

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    • Obiora A. excellent

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      • venkatesa reddy D. lots of teachings in case helped to clear doubts

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        • R A. dear sir...
          how do you manage highly eccentric stenosis especially wiring technique?
          small curved tip.?

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          • Daniel W. Great question! Well this can be very challenging. Basically the shape depends on the anaytomy. I personally do not use preshaped wires and shape my wire in relation to the anatomy. The type of wire can play a role too. Sometimes you choose also tapered polymeric wires.

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