Complex coronary cases
Staged Intervention of Multiple Calcified Lesions in RCA using BMS – July 2011

Case: 78-year old male with crescendo exertional angina (CCS class III) and SOB for one month. Patient had recent gastrointestinal bleeding requiring blood transfusion and upper endoscopy revealed duodenal ulcer. Cardiac cath on May 17, 2011 revealed 2V CAD (D2 and RCA) with normal LVEF. Patient underwent successful PCI of D2 using Integrity BMS. Now for staged intervention of multiple calcified lesions in RCA, again using BMS due to gastrointestinal bleeding.

1:17:43

Q&A
Q
Besides for reducing DAPT duration, are there any other situations for which you will use BMS?
A.

In two other situations; 1) STEMI with large residual thrombus burden despite thrombectomy and 2) large size SVG lesions


Q
Which is your BMS of choice? Why?
A.

Integrity of Medtronic at present and is largely due to better delivery compared to other BMS.


Q
What is the percentage of BMS used at your institution?
A.

12-15%


Q
What is the duration of DAPT you recommend for BMS? Would you continue Aspirin though, and at what dose?
A.

For BMS DAPT is for 1 month only in cases where surgery is planned; otherwise routinely prescribed for 1 year. Aspirin 81mg daily is continued lifelong.


Q
Any benefit of Prasugrel instead of Clopidogrel for BMS?
A.

Yes as shown in TRITON trial Prasugrel had the same efficacy and lower stent thrombosis advantage over Clopidogrel even in BMS.


Q
In a GI bleed post PCI, at what level will you transfuse if the patient is asymptomatic?
A.

There is no lower limit now a days and we have managed even Hct of 18-20% without transfusion, as long as pt is not tachycardic/symptomatic. There have been trials to answer the question and have shown that for similar drop in Hct, pts with transfusion do worse vs. managed conservatively.


Q
How will your patient now fare, when you have used several DES in a situation where you wanted to use BMS to reduce the risk of GI bleeding?
A.

Yes that is a challenge and we will manage the pt more proactively from GI point of view; start PPI and watch out for early sign of bleeding and get upper endoscopy ASAP, GI bleeding is suspected.


Q
What are some key points for the safe use of the Guideliner "daughter" catheter?
A.

It just needs to be slowly advanced into the vessel over the guidewire. Also don’t aspirate the guidecatheter while guideliner is in place as it may aspirate air column. Also make sure ACT continues to be around 300sec as it tend to make some blood clots at lower ACTs especially when used in 6Fr guides.


Q
In what particular situations do you use it?
A.

For extra back up support for stent/balloon delivery in tough, angulated cases (native or SVGs) and CTOs.


Q
What single message do you want to give the viewers on your second anniversary as to why they should watch your webcast?
A.

The main theme and focus of the live cast after 24 cases remains the same; Skillful demonstration of procedural technical steps in safely performing the complex cases.


comments

Join the Discussion

One thought on “Staged Intervention of Multiple Calcified Lesions in RCA using BMS – July 2011”

  1. Gunjan says:

    Very I. M. P information to avoide this type’s of casess


Leave a Reply

Your email address will not be published. Required fields are marked *

suggestion
Suggestions
PCI of Complex LAD D1 Bifurcation with Mini-crush Technique
Tags: | |
Views 33

Case and Plan: 84-year-old female presented with new onset CCS Class III angina with positive SPECT MPI for multivessel ischemia. A Cardiac Cath on January 28, 2020 revealed 3 V CAD: 90% proximal RCA, subtotal large proximal LAD/Diagonal bifurcation lesion, 80% small LCx-OM1, SYNTAX Score of 21 and LVEF of 55%. Patient had a successful […]


OCT Guided Complex Intervention of LM and Long Calcified Aneurysmal LAD – January 2020
Tags: | |
Views 464

Case and Plan: 76-year-old female presented with new onset CCS Class III angina with positive SPECT MPI for mild lateral ischemia. A Cardiac Cath on January 6, 2020 revealed 3 V + LM CAD: 70% distal LM, 80% proximal LAD/D1 bifurcation, 80% long calcified aneurysmal mid LAD, 80% LCx-OM1, SYNTAX Score of 35 and LVEF […]


OCT Guided PCI of Calcified LAD Bifurcation using 2-Stent + OA – December 17, 2019
Views 761

Case and Plan: 67-year-old male controlled NIDDM, presented with CCS Class I angina and positive stress echo for multi vessel ischemia. A Cardiac Cath on August 9, 2019 revealed 3 V CAD: calcified 80% mid LAD and D2 bifurcation, 70% distal LAD, CTO mid RCA and CTO proximal LCx, SYNTAX Score of 38 with moderate […]


Imaging Guided Calcified LM PCI with Interactive Discussion about EXCEL Trial Results by Dr. Gregg Stone and Dr. John Puskas – November 2019
Tags: | | |
Views 1332

Case and Plan: 77 year-old male with stable class II angina and exertional dyspnea was noted to have calcified 90-95% left internal carotid artery stenosis on carotid duplex for ongoing neurological symptoms. A Cardiac Cath on November 18, 2019 as the part of pre-op evaluation for carotid endarterectomy revealed calcified severe 2V (RCA and LCx) […]