CINE
775/47
Known
case Unstable Angina, Female 74 years previous
PCI, present with Unstable Angina
CAG:
Found severe mid CLX stenosis with acute
ankle takes off from LM. The lesion showed
90 % stenosis with side branch at the lesion
(Fig.
1)
 PCI
procedures
| • |
GD 6
Fr JL 4 was seated (Fig.
2) |
| • |
Tried BMW Universal
190 cm, but GW prolapsed to LAD |
| • |
Changed GW to be Whisper
190 cm, and tried to access to the lesion,
but could only negotiate to the lesion
then prolapsed to SB, so it could not
pass through the lesion as well. ( could
not negotiate cross the acute bend at
SB before the lesion) |
| • |
Tried Aqua T3 to back
up support the GW to cross the lesion,
the BDC could not pass the lesion and
GD was not seated well. |
| • |
Changed GD to be EBU
4 6 FR, better seated. |
| • |
Tried old whisper
to CLX, but still prolapsed to SB |
| • |
Tried Floppy II, failed
as well |
| • |
Changed to use Pilot
150, used double curve shaped technique
to help negotiation across the acute
bend. The GW could pass the lesion smoothly.
(Fig.
3) |
| • |
Dilated with Aqua
T3 1.5 X 15. (Fig.
4) |
| • |
Stented with Mini
Vision 2.5 X 8 mm. (Fig.
5) |
| • |
The procedure was
done with satisfy result. |
Comment
This
challenge case with very acute bend of artery,
need the GW with very good torque ability,
good tip control and support and less likely
to prolaps from the lesion did help the
successful of procedures.
|
