Slides
Primary Stenting with Embolic Protection(PercuSurge GuardWire) in a Patient with ST elevation MI
- Operator : Teguh Santoso
| Primary Stenting with Embolic Protection(PercuSurge GuardWire) in a Patient with ST elevation MI |
| - Operator : Teguh Santoso, MD |
| Case presentation |
| The patient was a 79 year-old male. He was admitted to the emergency room with persistent chest pain for 3 hours. He had a ("30 year history of smoking" or "30 packs per year") of smoking as a coronary risk factor. Baseline ECG showed ST elevation on leads II, III, aVF. Cardiac enzymes were elevated on admission. He underwent emergency coronary angiography for primary PCI. |
| Baseline coronary angiography |
| 1. Coronary angiogram showed a subtotal occlusion
with large amounts of thrombus burden in the proximal and mid RCA with TIMI
2 flow. Multiple lesions were also noted in PL branch and PDA (Figure
1).
2. The LAD and LCX were normal. |
| Procedure |
| An 8F sheath was inserted through the right femoral artery and the right coronary was engaged with an 8F Judkins catheter. After coronary angiography, a distal protection device (PercuSurge) was placed proximal to the bifurcation point in an attempt to prevent distal embolization following intervention. Complete distal occlusion of the distal RCA was verified with contrast injection. After complete occlusion (Figure 2), the large burden of thrombus was initially aspirated using an export catheter. After deflation of the balloon, the following angiogram revealed a diffuse 70% luminal narrowing in the mid RCA (Figure 3). The distal protection balloon was reinflated before stenting. A 23mm x 3.5mm Bx hepacoat stent was implanted in the mid RCA lesion under distal protection (Figure 4). Following stent implantation, the stagnant blood and debris in the RCA were aspirated using an export catheter (Figure 5). The final angiogram showed a well deployed stent without residual stenosis or dissection. TIMI 3 flow was noted (Figure 6, Figure 7) shows a micro-filter containing some of the aspirated debris particles, which were shown to be composed of fibrin strands (thrombus) on pathologic examination. |
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