Complex coronary cases
PCI of SVG to OM1 – April 2012

68-year old male with prior CABG x1 + AVR in 2005, presented new onset crescendo angina CCS Class III. A stress MPI revealed large anteroapical and moderate inferolateral ischemia. Cardiac cath on March 20, 2012 revealed 3 vessel CAD, stenosed SVG to OM1, normal LV function and normal aortic bioprothesis. He underwent successful intervention of culprit mid and distal LAD using Xience V DES and Tryton BMS in D2 under Tryton bifurcation Trial. Patient is now planned for PCI of SVG to OM1.

1:09:02

Q&A
Q
Can you briefly decribe the Tryton trial?
A.

Tryton trial is comparing a dedicated sidebranch bare metal stent with PTCA only of sidebranch with DES in the main vessel in both the groups.


Q
Would there be a role for FFR in this situation?
A.

Not in the Tryton trial but certainly in the usual day to PCI; FFR is playing a major role to see if we should go after the sidebranch many of them just look hazy and of borderline stenosis.


Q
In the next decade, with the expansion of hybrid labs, do you see the complete demise of use of SVG?
A.

Not really as many of complex CAD such as heavily calcified lesions and CTO's still will require CABG.


Q
How many hybrid procedures does your institution do?
A.

Very little. May be 4-5 per year.


Q
What is your algorithm - first PCI, then LIMA-LAD?
A.

Best approach is first LIMA to LAD and then PCI just a day before the discharge. Hence CABG can be done while pt is not on plavix.


Q
What is your anti-coagulant strategy during hybrid procedures?
A.

All cases with Bivalirudin and avoid GP IIb/IIIa inhibitors. Clopidogrel is preferred ADP receptor blocker.


Q
Is there problems with insurance reimbursements for the hybrid procedures?
A.

So far we have not encountered the insurance barrier for hybrid cases.


Q
Do you see a decline for emboli protection devices for SVG management?
A.

agree with the statement that despite the Class I recommendation for DPD use in SVG PCIs, they are needed in only <25% of the cases. That exactly is the national trend as per ACC-NCDR data.


Q
What are your biggest concerns about the M-Guard device?
A.

Biggest concern about M-guard device is that it is not coated with the antiproliferative drug at this time.


Q
Of all emerging technologies for SVG treatment, which appears the most promising to you?
A.

Still M-guard stent has the best promise as there are not much emerging technology in the field of SVG PCI.


comments

Leave a Reply

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

suggestion
Suggestions
Unstable Complex LCx CTO Bifurcation Intervention – May 2020
Tags: | |
Views 461

Case and Plan: 50-year-old male on HD, extensive CAD presented with progressive CCS Class II angina and high risk SPECT MPI for multivessel ischemia as preop for renal transplantation. A Cardiac Cath on December 2, 2019 revealed 3 V CAD: 95% LCx bifurcation with CTO ISR of OM1 (Medina 1,1,1), FFR+ 60% mid LAD/D2 bifurcation […]


STEMI in the COVID Era – April 2020
Views 1621

Case and Plan: 43-year old male presented to ER late with anterior STEMI 40 hours after the symptom onset of chest pain, cough and low grade fever. A Cardiac Cath on March 23, 2020 revealed 1 V CAD: thrombotic occlusion of proximal LAD with LVEF = 20%. Patient underwent successful intervention of proximal LAD using […]


Ostial LAD CTO PCI via Retrograde Approach – March 2020
Tags: | |
Views 2532

  Case and Plan: 52-year-old male with COPD and OSA presented on January 31, 2020 with acute hypercarbic respiratory failure requiring intubation and ruled in with peak Troponin of 12 (Type 2 MI) and acute systolic heart failure NYHA Class IV. Patient was stabilized on medical therapy and extubated. A Cardiac Cath on February 3, […]


PCI of Complex LAD D1 Bifurcation with Mini-crush Technique
Tags: | |
Views 1601

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 […]