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A Case of Left Main Complex Coronary Artery Angioplasty

Dr Kaisar Nasrullah Khan, Dr Mujibur Rahman, Dr Samsun Nahar, Dr Rajib Dhar

A 47 year old gentleman was admitted to the United Hospital with the complaints of central chest pain on mild exertion for 7 days. As he had a medical history of hypertension and dyslipidemia, he decided to undergo cardiac screening on his own.  

His resting ECG showed a sinus rhythm at 62 bpm and Echocardiography revealed no regional wall motion abnormality with normal LVEF-65%. During the treadmill test patient complained of chest pain and ECG showed ST elevation in aVR and ST depression in all other leads and in stage II that was strongly positive. He was then advised for urgent CAG (Coronary Angiography) which showed TVD (Triple Vessel Disease) with severe left main disease. His syntax score was total 25, EuroSCORE II 0.85 and thus he was advised for urgent CABG.

After CAG the patient suddenly developed chest pain. ECG showed ST elevation in lead aVL and V1 and gross ST depression in all other leads with bradycardia & hypotension.

Then TPM was done with inotropic support and prepared the patient for urgent PCI because patient was haemodynamically unstable and there were no other options available at that time so we planned DK Crush technique for LM stenting.

Then XB-3.5 (7F) PTCA guiding catheter and two whisper MS wire were taken. One was placed in LAD and another was placed in LCX. Both the lesions in LCX and LAD were predilated in succession with 2.5 mm x 10 mm, 2.0 mm x 11 mm and 2.5 mm x 15mm balloons, inflated at 12 ATM. Covering the lesion in LCX, 3.0 mm x 15 mm drug eluting stent was deployed at 12 ATM. Then the lesion in LAD was predilated in succession with 2.5 mm x 15 mm, 3..0 mm x 12 mm balloons inflated at 12 ATM. Covering the lesion in LM to LAD. 3.0 mm x 18 mm drug eluting stent was deployed at 12 ATM. Instent kissing balloons dilation was done with (LAD) 4.0 MM X 15 MM (LCX) 3.5 mm x 12 mm balloons, inflated at 16 ATM. Final angiogram showed the LCX & LM to LAD were well revascularized with good distal flow.

This case was presented on 11 October 2015 in ‘TCT 2015’ in San Francisco, California, USA.  

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