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Case Presentation

Case Presentation. Georgios I. Papaioannou, MD Athens Medical Center Cardiac Catheterization Laboratory. Clinical History.

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Case Presentation

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  1. Case Presentation Georgios I. Papaioannou, MD Athens Medical Center Cardiac Catheterization Laboratory Global Advisory Board Meeting

  2. Clinical History • 87 year old male with prior hx of CAD s/p CABGx3 in 2001 (SVGLAD, SVGOM, SVGRCA), s/p Permanent Pacer in 2004, had 2 recent admissions for UA /Biomarker positive ACS stabilized with Rx – in good physical shape • CRF: DM, HTN, Dyslipidemia, CRF (Crea=1.9) • Echo with EF=45%, anterior+inferior hypokinesis, moderate MR – no stress test performed – referred for angiography Global Advisory Board Meeting

  3. Angiogram 1 mo ago–Native LCA Global Advisory Board Meeting

  4. Native RCA Global Advisory Board Meeting

  5. SVGOM Global Advisory Board Meeting

  6. SVGRCA Global Advisory Board Meeting

  7. SVGLAD Global Advisory Board Meeting

  8. SVGLAD Global Advisory Board Meeting

  9. Angiogram results • Severe 3VD (LAD 70% prox and diffuse 70-80% after SVG anastomosis, 100% CX and severe calcified prox RCA 80% and 90% at origin of PLV) • 60% SVG LAD eccentric stenosis, 100% SVGRCA, Mild disease of SVGOM at its origin • Any intervention postponed for 2nd time after appropriate planning and checking the response to given dye (110 ml) • Crea at day 52.3 returned to 1.8 after 2 weeks and stabilized at that value – returned for PCI of RCA+LAD Global Advisory Board Meeting

  10. PCIRCA Global Advisory Board Meeting

  11. PCIRCA (PLV) Endeavor Resolute 2.75 x 18 Global Advisory Board Meeting

  12. PCIRCA Endeavor Sprint 3.5x18 Global Advisory Board Meeting

  13. PCIRCA final Global Advisory Board Meeting

  14. PCILAD via SVG Endeavor Resolute 2.5x12 + 2.5x14 Global Advisory Board Meeting

  15. PCI of SVGLAD Endeavor Resolute 2.75x12 Global Advisory Board Meeting

  16. PCILAD Final Global Advisory Board Meeting

  17. Case Characteristics- Conclusions • Vessel tortuousity + severe calcification (RCA) – necessity of a deliverable stent • Vessel size + SVG graft – necessity of reduced probability of ISR • Increased age - ? Reduced duration of dual antiplatelet Rx Global Advisory Board Meeting

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