Dr Hore D . R MD (Medicine) DNB (Cardiology) MD (Medicine) , DNB (Cardiology) Interventional cardiologist W kh dH i l N Wockhardt Hospital , Nagpur India
Dr Hore D . R MD (Medicine) DNB (Cardiology)MD (Medicine) , DNB (Cardiology)
Interventional cardiologistW kh d H i l NWockhardt Hospital , Nagpur
India
Mr. B. H . 62 Yrs Male Symptoms : Chest pain since 8 hours Risk factors : HTN DM Risk factors : HTN ,DM Diagnosis : Acute anterior wall STEMI , g ,
Acute LVF (Killp class II)
ECG : i llAcute Anterior Wall
STEMI
2 D ECHO :LAD Territory Akinetic LVEF – 30 % Mild MR
Primary PCI to IRA
IABP Support - If needed pp
ACS – AWSTEMI S LV S t li D f ti Severe LV Systolic Dysfunction
Left Dominant Systemy
Diff F th PAMI C Differs From other PAMI Cases ACS – High Risk Subset gWire Negotiating point – Ostial LAD no stump L k A Ch i T l O l i Looks Acute on Chronic Total Occlusion
RFA Guide EBU 7 Fr Guide – EBU 7 Fr
1.25 X6 MM SPRINTER @ 14 ATM
2 X 12 MM SPRINTER BALLOON AT 12 ATM 12 ATM
• Primary PCI of flush total occlusion of Ostial LAD with dominant LCX is challenging LAD with dominant LCX is challenging
• In this case we observed acute on chronic total occlusion of culprit vessel - A novel total occlusion of culprit vessel A novel findingLi it ti i bl i li ti• Limitation is unable visualize ostium
• IVUS is useful in such cases to navigate wireg• Hooking of ostium is initial step of wire
manipulation manipulation
Prolong manipulations in patients with ti l l d i t LCX l d t particularly dominant LCX can lead to
catastrophic complications like LMCA p pdissection , thrombus formation