1. Shanghai Jiaotong University
PCI for a Patient with Multivessel Disease and Renal Transplantation --- Case Report
Zhang Qi, MD
RuiJin Hospital
Shanghai Jiaotong University
School of Medicine

2. Case Introduction Male, 70y OMI (ant), SAP, HBP
Previous MI : Jan, 2000
Other history : renal transplantation due to 10ys of chronic renal failure in 2007
EKG: Q wave in anterior leads (V1-4)
UCG: LVEF 0.41
Serum Cr 108umol/L (1.22mg/dl), estimated Ccr=58.6

3. CAG Results

4. Interpretation and Strategy
Multivessel disease with compromised LV function
CABG
PCI
Renal Status: Cr 108umol/L, three years after renal transplantation
Medication: still on anti- rejection regimen (predinisone and CTX)
LAD: Succeed
LAD: Fail
Partial Revascularization w/ PCI & medication
Medication only

5. Renal Function Consideration
Estimated maximal contrast consumption
73.5kg in body weight, with baseline Cr 108umol/L
MRCD=301ml
Hydration strategy
Iso-osmolar contrast

6. Finecross Microcatheter + Miracle 3.0 Double Wires: Miracle 3.0/4.5
PCI for LAD
7F EBU 3.75 G.C.
Finecross Microcatheter + Miracle 3.0
Double Wires: Miracle 3.0/4.5
“4.5 in microcatheter”

7. Change to Pilot 150 in microcatheter, Micracle 3.0 into diagonal area
PCI
Change to Pilot 150 in microcatheter, Micracle 3.0 into diagonal area
Pilot 150 failed to reach the LAD middle true lumen, but Micracle 3.0 placed into distal diagonal branch

8. PCI
Strategy changed to predilate the diagonal first with a 1.25x15mm balloon

9. PCI Re-efforts in LAD, with Conquest-pro wire
True lumen placement, proved by multiple projections

10. PCI Predilate LAD with 1.5x15mm Apex-Push Balloon
True lumen position of Conquest wire re-confirmed

11. PCI Predilate with 2.0x20mm Balloon
After predilatation, and stents were ready

12. PCI
3.0x36mm SES
16atm
3.5x33mm SES
16atm

13. Final Results of LAD PCI
Post-dilate with 3.5x33mm stent 18atm
Final Results

14. Temporary Conclusions
2hours, 400ml contrast (iso-) consumption
Both doctors and patient are tired
Elective PCI for RCA and LCX was planned
Hydration strategy was applied before PCI and continued for 12hours after PCI, with 1ml/kg/h NS intravenously infusion

15. Elective PCI for RCA & LCX 2010-2-23

16. 30 minutes and 100ml contrast consumption !
PCI for RCA & LCX
3.0x36mm SES
2.75x23mm SES
30 minutes and 100ml contrast consumption !

17. Renal Function Monitoring
Cr.
(umol/L)
BUN
(mmol/L)
108.0
9.1
113.0
6.8
106.0
7.2
102.0
8.1
97.0
6.7

18. Take Home Messages
In CAD patients with co-morbidities, including severe noncardiac conditions (renal, lung), CABG may be contra-indicated.
PCI may leave to be the only choice to improve survival status.
Advances in PCI for CTO lesions: equipments (wires, microcatheter,etc) , techniques (retrograde, multiple wires, etc.)

19. Take Home Messages
In some circumstance in CTO PCI, wire is easy to reach the branch vessel distal to occlusion, and predilate the branch distal to occlusion may help to reach the main vessel by another wire.

20. Thanks