Slides
Successful Primary Stenting for Acute Right Coronary Artery Occlusion with Concomitant Chronic Total Occlusions of Left Anterior Descending Artery and Left Circumflex Artery
- Operator : Cheol Whan Lee
Successful Primary Stenting for Acute Right Coronary Artery Occlusion with Concomitant Chronic Total Occlusions of Left Anterior Descending Artery and Left Circumflex Artery |
| - Operator: Cheol Whan Lee, MD |
| Case presentation |
| A 56 year-old man was rushed into the emergency room due to a sudden collapse while he was singing in a Karaoke 15 minutes ago. During transfer, cardiac resuscitation had been performed by emergency paramedics. He was comatous and showed no pulse and no respiration. Initial ECG showed ventricular fibrillation and sinus rhythm was recovered after six shots of electrical defibrillation with 360J. ST elevation was shown in inferior and lateral leads. He had no known coronary risk factor. The left coronary angiogram showed chronic total occlusion of proximal LAD and distal LCX (Figure 1, Figure 2) and the right coronary angiogram showed diffuse narrowing of proximal RCA with complex plaque (Figure 3) with well developed collateral flow to the LAD and LCX (Figure 4). |
| Procedures and clinical progress |
| An 8F JR 3.5 guiding catheter was engaged into RCA ostium and the proximal RCA lesion was predilated with a 4 x 15 mm Sprinter balloon (Figure 5). Then, a 4 x 30 mm Driver stent was placed at the lesion and deployed at 16 atm to 4.31 mm (Figure 6). Final angiograms showed a successful result with TIMI 3 flow (Figure 7). Echocardiogram showed inferoposterior akinesia with global severe LV dysfunction (LVEF=30%). He has been weaned from mechanical ventilation and IABP after 2 hospital days and his mentality has been improving. |
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