11:55 CASE 9 - Reimers
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Transcript of 11:55 CASE 9 - Reimers
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