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

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Presentation on theme: "Management of LCA-LM dissection. Bogdan Gorycki American Heart of Poland Ustron, Poland."— Presentation transcript:

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

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

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

5 LCA: RAO30, Caudal 15

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

7 Fast diagnosis and problem solving Diagnosis: Spiral dissection of LM, LM bifurcation, proximal Cx and proximal LAD/D1 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) 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 BX Velocity 3.5x23mm 18 atm., 15 sec. After LM/LAD stenting Time: 22:57 Aortic pressure: 80/40 mmHg HR:120/min. Aortic pressure: 100/60 mmHg HR 90/min. Time: 23:00

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

11 Final result: LCA:RAO30, Caud22LCA: LAO52, Caud 14 Time: 23:16

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

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


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