Case

Rescue PCI in an Extensive AMI in a 30 Year Old Male

A.M. Thirugnanam

February 21, 2012

Operator(s)

A.M. Thirugnanam, MD,FSCAI, Ph.D., MSICP Senior Interventional Cardiologist

Affiliation

Ipcard Cardiac Care Center Hyderabad, Andhra Pradesh, India

Facility / Institute

Kamineni Hospitals, King Koti, Hyderabad, Andhra Pradesh, India

Clinical History

A 30 year old male came to emergency department with severe chest pain at 7:30 AM complaining of severe chest pain since 2:00 AM. At the time of arrival his BP was 110/80mmhg, HR was 104/min, saturation in room air was 96%, and RR was 19/min, Lungs were clear, a third heart sound was audible. cTnI measured 1.9ng/dl, CK measured MB-29, CK-NAC measured 97, LDH measured 654, and SGOT and SGPT were slightly elevated. Kidney function was normal.

Angiography

1) LMCA-normal
2) LAD-Proximal 100% occlusion (Figure 1)
3) LCX- normal and non-dominant
4) RCA-normal and dominant (Figure 2).

Procedure

The LM was engaged with an EBU guiding catheter. We tried to cross the LAD lesion with a BMW guidewire, but it went to D1 (Figure 3). Dilation with a 1.25mm Terumo balloon between LAD and D1 (Figure 4) resulted in no flow. We took a second BMW guidewire and tried to cross the LAD, but it went into D2 (Figure 5). We predilated and tried to aspirate thrombus with an Export catheter (Figure 6). Finally, we found the distal LAD and placed the D2 guidewire into the distal LAD distal. We tried many attempts to aspirate maximum thrombus, but still there was TIMI-II flow (Figure 7). We decided to cover the LAD with stents (Figure 8). First we stented distal lesion with a 3x24mm ML-8 cobalt cromium Abbott stent (Figure 9); however, we detected a dissection distal to the stent (Figure 10) that we covered using a 2.5x15mm ML-8 (Figure 11). Finally, we stented proximal portion with a 3x18mm ML-8 stent (Figure 12) followed by post-dilation of each overlap segment (Figure 13). Final results revealed TIMI-III flow and no residual thrombus or dissection (Figure 14).

Conclusion(s) / Result(s)

Post procedure angiomax infusion was given and patient was discharged on 5 day in stable condition.

Comments/Lessons

None

Gallery