A 43 year-old male presented with chest pain with left ventricular failure. ECG shows ST elevation in lateral leads. The first tropinin was 1.0. Patient was started on heart failure therapy, and a second troponin was sent; because of ongoing chest pain, the patient was taken to the cath lab for angiography.
LAD: No significant stenosis
LCX: 80% proximal stenosis (Figure 1)
Because of acute angle, the LCX was wired with some difficulty. After repeated attempts even with a buddy wire and a deep throat guiding catheter technique, a 2.75x16mm drug-eluting Resolute stent (Medtronic) could not cross the angle between left main and the LCX. During this process, the stent came off the balloon and was parked in the left main (Figure 2). A small 1.5x10mm balloon was used to attempt to push the stent into the LCX, but was unsuccessful; and the the balloon passed beyond the stent (Figure 3, Figure 4, and Figure 5). As the balloon was withdrawn, the stent moved back into the proximal LCX. Then another guidewire (Cougar, Medtronic) was used to cross the struts of stent. the original stent balloon was parked behind the stent, and the 1.5x10mm balloon was pulled back into the stent (Figure 6). The extra guidewire and the second balloon were taken out (Figure 7). The stent was deployed using 1.5x10mm and then 2 x10mm balloons (Figure 8). Finally, the original stent balloon was used for post-dilation (Figure 9, Figure 10).
Conclusion(s) / Result(s)
There was TIMI III flow at the end of procedure and the patient becomes asymptomatic with no rise in tropinins.
Conflicts of Interest