Presentation is loading. Please wait.

Presentation is loading. Please wait.

Management of LCA-LM dissection.

Similar presentations

Presentation on theme: "Management of LCA-LM dissection."— Presentation transcript:

1 Management of LCA-LM dissection.
Bogdan Gorycki American Heart of Poland Ustron, Poland

2 Case report 42 years old female Effort angina, diseaness, syncope
Hypertension Diabetes mellitus Hypothyreosis Overweigth (body weight 120 kg)

3 Non-invasive tests UKG: LV function normal EKG: ST/T changes at rest
Spiral CT: hypoplasia of left vertebral artery, no significant lesion in carotid arteries, right vertebral artery ostial lesion.

4 Further diagnosis The patient scheduled for coronary artery and carotid/vertebral angiogragphy

5 LCA: RAO30, Caudal 15

6 LCA: LAO 55, Cranial 22 Dissection LM/Cx Time: 22:50 Dissection LAD/D1

7 Fast diagnosis and problem solving
Diagnosis: Spiral dissection of LM, LM bifurcation, proximal Cx and proximal LAD/D1 Management: -stop diagnostic procedure -immediate proceeding to LM stenting: -6F JL Guiding catheter -two soft wires (BMW, Guidant)

8 Fast wiring of LAD and Cx
Time: 22:55 Aortic pressure: 90/50 mmHg HR: 110/min ECG: ST elevation. Chest pain treated with analgetics.

9 Direct stenting LM/LAD
Time: 23:00 Time: 22:57 Aortic pressure: 80/40 mmHg HR:120/min. Aortic pressure: 100/60 mmHg HR 90/min. After LM/LAD stenting BX Velocity 3.5x23mm 18 atm., 15 sec.

10 Cx stenting Stent Bx Sonic 3.5x13mm
Re-wiring Cx wire and predilatation Ostium Cx with2.5 balloon Stent Bx Sonic 3.5x13mm in position.

11 Final result: Time: 23:16 LCA:RAO30, Caud22 LCA: LAO52, Caud 14

12 One-stage VA stenting:
Direct stenting: BX Velocity 4.0x13mm Ostial stenosis (90%) of right VA artery

13 Conclusions LM stenting is life saving procedure in patients with LM dissection which occurs during diagnostic or therapeutic percutaneous coronary intervention. The procedure should be included to routine training and practice.

Download ppt "Management of LCA-LM dissection."

Similar presentations

Ads by Google