Summary

A 64 year old malay man was referred from Hospital Kota Bharu for angiogram. He has background history of unstable angina in 2004 where he first presented with chest pain. Upon discharge he had on and off chest pain on moderate exertion (CCS class II) and subsequently stress test was performed in April 2005. his exercise stress test showed significant ST depression at low work load (4.6 METS) over lead II, III, aVF and V5,V6.

Other significant past history

- Ex- Smoker. He stopped smoking about 4 years ago.
- Family history of ischemic heart disease.
- No history of diabetes, hypertension.

Current medications

- Aspirin 150 mg OD.
- Clopidogrel 75mg OD
- Isordil 20mg TDS.
- Vastarel 20mg TDS
- Metoprolol 25mg BD.
- Atorvastatin 10mg ON
- Ramipril 2.5mg OD

Examination: Unremarkable

Angiogram was performed on 22.08.2005 and showed a CTO to the RCA (Figure 1)

PCI Procedure

A 6F AL 1 guiding catheter was introduced via the femoral approach. A HT Pilot 150 was inserted into the RCA with the support of a Voyager 1.5-15mm (Figure 2). With little effort the wire managed to cross the CTO (Figure 3). The 1.5 Voyager was used to deflate the whole aretery from the proximal to the distal artery at 12-14atm for 10 sec each. A second Voyager of 2.5-20mm was used to further inflate the whole RCA vessel at 12atm for 10 secs each (Figure 4). The distal RCA was stented with a Mini Vision of 2.25-28mm for 12atm for 10 ses (Figure 5), the mid lesion was stented with a Mini Vision of 2.5-28mm for 12 atm for 10 secs (Figure 6) and lastly the proximal RCA was stented with a Vision of 12-3.0 overlapping 3mm over the mid stented segment for 14 bars for 10 secs (Figure 7). The overlapping segnments from prox to mid was post-dialated with a Powersail of 15-2.75mm for 16 atm for 10 secs (Figure 8).

The final PCI results was accepted well and successful (Figure 9).