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Case summary
Patient: male 77 y
Dyspnea and angina since several months
NSTEMI 26.11.16
3 vessels disease: several stenosis LAD, CX and RCA
culprit lesion LAD (with thrombus)
CTO IM branch und PD of RCA
Syntax score: 28
LVEF: 45%
Inferior and apikal akinesia
No valvular heart disease
Renal function: eGFR = 85 ml/min/1.73m2
CVRF: aHT, dysplidemia
How to treat this patient?
Syntax score: 28
EuroSCORE II: 2.2
STS-score: 1.2 for mortality
9.4 for morbiditiy and mortality
Proposed treatment: CABG, but patient refused
Todays planned procedures:
PCI of the LAD and diagonal branch
Ev. RCX PCI
Protocol
OptiRAY® (Ioversol)
Concentration 300 mgI/mL
Flow rate: 3.5 mL/ s
Volume: 112 mL
Total exposure : 0.8 Gy
Exposure time: 27 minutes
15 images / s low dose Philips
57 images mostly fluoro
Shooting date : 2016-11-03
Last update : 2021-06-09
Last update : 2021-06-09
OptiRAY® / Guerbet
Optiray® contrast agent is lower osmolar, lower viscosity and nonionic.
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Uncage coronaries - Episode 2 : uncage bifurcations, make the complex simple
A case based discussion
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Discussion around complex PCI
How to deal with complications?
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Quand le patient et l’angiographie racontent des histoires différentes
Pourquoi le diagnostic des anomalies ou dysfonctions microcirculatoires est important
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Bifurcation PCI, when finishing with one or two stents is not obvious
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Long RCA occlusion: antegrade or retrograde approach?
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Alexander P. Why DES in distal LAD ? BVS Absorb?
Daniel W. Hi Alexander. Thank you for your question. We know from the Absorb data that scaffolds perform worse than DES in smaller vessels, associated with a higher MACE rate. An alternative could be treating small vessels with DCB. The BASKET small study result will be presented in 2018 (DES vs DCB in small vessels). DCB are good in our experience when you have TIMI flow III, no more than a dissection A or B, and less than 30% residual stenosis.