when things might go wrong, usually they do (reverse murphy law technique) bernhard reimers andrea pacchioni Mirano
when things might go wrong, usually they do (reverse murphy law
technique)bernhard reimersandrea pacchioni
Mirano
BRIEF INTRO: the patient
Male, 57 yrs oldActive smoker, Hypertension, Dyslipidemia2012: NSTEMI • 80% mid LAD PCI w DES• 100% prox RCA unsuccesfull antegrade LVEF 54%optimal medical therapy (DAPT – β blocker – ACEI – statin - nitrates) 2013: positive stress test @ mid level
July 2013: diagnostic coronary angiography
strategy?
• Pump up medical therapy: add ivabradine/ranolazine
• RCA CTO: antegrade again
fix LM and then retrograde
Blunt stumpBig side branch Good septal collaterals
dye amount: 250 ml (iodixanol 320)
fluoroscopy time: 26’
radiation: 216090 milligray/cm2
in cath lab: 8 am to 10.15 am
introducers: 2 terumo destination 8 fr 45 cm
guiding cath: AL 1.5 SH asahi hyperion 8 Fr & Cordis XB 4 8 Fr
wires: asahi sion - sion blue - abbott bmw
microcath: Asahi corsair 150 cm
stent: abbott xience V 3.5 - 18 mm
balloons: quantum 3.5 - 15 mm
coils: 2 vortx 3 - 2.5 mm
ivus: Volcano
follow up
hs troponin peak 82 ng/l
hospital stay: 4 days
minimum pericardial effusion @ echo (completely resolved before discharge)
telephone FU: fine, living in sardinia, asymptomatic (ivabradine added)
what we learned
keep the entire screen (do not focus only on coronaries)
look for complications (also where you do not expect any)
have a panic box with inside: pericardiocenthesis set - coils - fast echo - covered stent