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Case 165: Manual of PCI - NSTEMI in an elderly patient

  Рет қаралды 4,035

Manos Brilakis

Manos Brilakis

6 ай бұрын

An 89-year-old woman presented with NSTEMI and was found to have distal left main disease along with stenoses in the proximal/mid LAD and the left main. Wiring the circumflex was challenging due to angulation but was eventually successful using a Samurai RC wire. The LAD was also wired with a workhorse wire. A Sasuke dual lumen microcatheter was used to advance a guidewire into the first obtuse marginal branch that had a severe ostial stenosis. The OM1 was predilated. Attempts to deliver a 2.5x26 mm Orsiro to the circumflex lesion failed due to angulation, even after using a buddy wire and a guide extension. A Wiggle wire was inserted into the circumflex using the Sasuke microcatheter followed by successful stent delivery and deployment. There remained significant ostial disease in the OM1 but it could not be rewired and the patient did not have any chest pain or ECG changes, hence it was left as is. The LAD and left main were stented with DES jailing the circumflex (provisional stenting) with a nice final result.

Пікірлер: 13
@matheuscsmed
@matheuscsmed 6 ай бұрын
Thank you, Matheus Silva
@shangz0216
@shangz0216 6 ай бұрын
Thanks for the excellent case presentation.
@fatherabdul
@fatherabdul 6 ай бұрын
Super work as always Manos 🎉you always teach us something new… 🌴🌴
@abaiturdubaev4105
@abaiturdubaev4105 6 ай бұрын
Perfect as always, maestro👏🏻
@cristianolisi3001
@cristianolisi3001 6 ай бұрын
Well done, good work.
@pranomc
@pranomc 5 ай бұрын
Is there an edge dissection in the Left main stent?
@sachindev220
@sachindev220 5 ай бұрын
Sir is there any edge dissection in LMCA?
@user-ku9lm2ic1i
@user-ku9lm2ic1i 5 ай бұрын
Hello. It`s very interesting case. A have one question. Why did the LM show a diameter 5 mm on IVUS, but POT 4mm?
@nisennananem
@nisennananem 5 ай бұрын
5.19 was the minimal lumen area, not the diameter. He didn't show a normal reference diameter in the IVUS run, but probably the normal diameter in the left main was 4mm, considering his choice for the POT
@mahmoud_elrayes
@mahmoud_elrayes 6 ай бұрын
Excellent approach.What is your opinion regarding stenting from proximal to distal in case of LM / LAD long lesion to precisely adjust LM stent then go for LAD stent ? Thanks
@atefkhamis7286
@atefkhamis7286 6 ай бұрын
Great
@NikhilJha89
@NikhilJha89 6 ай бұрын
Excellent case Will you do ffr in rca? Deb for smaller om? Can we use two different stent brands in same patient?
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