81 yrs, F known CAD s/p with prior PCIs and HFrEF. Presented with decompensated HF and +TnI with Type 2 NSTEMI. BNP 3956, managed aggressively for HF & CAG. Known extensive cAD with prior PCIs x3, last one in 2019. H/o prior Mis with LVEF 32% on GDMT for HFrEF & BiV-ICD Recent echo revealed mod-severe MR, mild AS and EF 23%. Cath on October 26, 2022 revealed calcific exytensive 3 V CAD with distal LM trifurcation involving prox LAD, ostial Ramus and proximal LCx with RCA DES ISR and Syntax score 42. Pt was referred to CTS for CABG+MVR but declined due to multiple comorbidities and low EF. After Heart team discussion, high risk Protected PCI was considered a viable option for dLM.
Aspirin, Ramipril, Furosemide, Spironolactone, ISMN, Carvedilol, Linagliptin, Insulin, Atorvastatin, Plaquenil.
Now planned for imaging guided PCI of dLM trifurcation using Rotational atherectomy and dedicated 2 stent technique with Impella LV assist.