Unprotected LM Stenting in Rapidly Progressive of LM Disease Without the Use of IABP

A. M. Thirugnanam
A.M.Thirugnanam Sr. Interventional Cardiologist
Kamineni Hospital, Hyderabad, India
Facility / Institute
Ipcard Cardiac Care Center, Musheerabad, Hyderbad, India
Clinical History
A 68 year old female with known hypertension and bilateral knee joint replacement 2 years previously, but no diabetes, had mild CAD treated with medical management. For the last 4 months, she was having CCS-4 angina. ECG showed NSR and nonspecific ST-T changes in all leads. 2D-echo was normal with a left ventricular ejection fraction of 65% and regional wall motion abnormality in the LAD territory. Troponin was negative.
Angiography 6/6/2010:
1) LM: mild disease (Figure 1)
2) LAD: proximal mild disease
3) LCX: non dominant and normal
4) RCA: dominant and normal.

Angiography 1/19/2012:
1) LM: 70% eccentric lesion (Figure 2)
2) Syntax score: 23.
Bivalrudin was given during procedure and after the procedure according to weight along with a loading dose of clopidogrel-600mg, aspirin-325mg, and atorvastatin-80mg. The LM was engaged with a JL-6 Fr guiding catheter through the right femoral approach (Figure 3). Two BMW guidewires were placed in distal LAD and distal LCX (Figure 4). Predilation was performed with a 3x10mm Maveric balloon at 10atm (Figure 5). Finally, a 4x12mm Xience Prime (Abbott) stent was deployed at 14atm with flaring of the ostium using the same stent balloon at 16atm pressure. Final results showed TIMI-3 flow, and no residual dissection (Figure 6).
Conclusion(s) / Result(s)
The patient tolerated the entire procedure and was kept in the ICCU for 2 days.
Very fast progression of LM disease is a major concern in older adults. Recent Syntax results gives confidence regarding unprotected LM stenting with less than 30 Syntax score.
Conflicts of Interest

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