60 yrs old male, had no significant medical and surgical history. One evening the patient shifted from one hospital to our tertiary care center with the complaints of severe chest pain, gums and nose bleeding after thrombolysis with STK in STEMI of IWMI. His BP-60/80mmhg, HR-120, LVEF-50%, ECG- ST elevation in inferior leads. saturation-96% at room air, RBS-115 mg/dl, Creatinine-1.2, urea-25 mg/dl, cTnI-15 ng/dl, other cardiac enzymes all elevated more than 3 times. TLC-11500, Platelets-35.000, ACT-1200 sec.
Coronary was done under right radial artery
LAD- type III, and normal
Diagonals are normal, (Figure 1)
RCA-proximal 95% occlusion (Figure 2)
No loading dose of clopidogrel and aspirin, no heparin and other anti coagulation. Pre cath cock tail without heparin.Patient was given bolus IV fluids and maintenance IV fluids. RCA ostium was engaged with 6FR JR-3.5 guide catheter. Proximal RCA lesion was crossed with out any difficulty with BMW guide wire 0.014 and kept in distal RCA. 3*15mm multi link cobalt chromium, (Abbott) stent was deployed directly without predilatation (Figure 3). Second time inflation was done with the same stent balloon with 15 atm pressure (Figure 4). Final results revealed TIMI-III flow and no residual thrombus found. No anti thrombin and anti coagulation were given during and after procedure.
Conclusion(s) / Result(s)
Final results was excellent, no residual thrombus or procedure related complications were seen. patient was discharged on third day with statin, nicorandil, and low dose ARB.
Conflicts of Interest