Complex coronary cases
Imaging Guided PCI of DES CTO RCA – July 2020

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57 year-old male with extensive CAD and PCI’s presented with crescendo angina on 8/20/2019 and Cath revealed 3 V CAD with DES CTO of RCA and normal LV function. CABG was recommended, but declined and patient did well on MMT. Recently started having angina and underwent Rota DES PCI of LAD/D1 bifurcation. Now planned for OCT guided complex PCI of DES CTO of RCA using Rota and DES.

What are ongoing Covid-19 precautions that you are taking in the CVL?

Most important precautions besides checking for symptoms (fever, cough) and testing all pt for Covid-19 antigen before the procedure, are the appropriate use of PPE by the cath lab staff based on the Covid test status. If Covid negative, then routine regular precautions of face coverings for pt as well as the staff suffices. If PUI or Covid+ in last 90 days even if Covid antibody +, these cases are done in one dedicated cath room (#1) with additional precautions of face shields and have two cath lab teams (one remains in the room and other outside to provide needed equipments). At the end of case, one hour room cleaning and disinfecting before the next case is strictly done.

Have elective cases begun returning?

Yes elective cases have started coming back and our June 2020 volume was 81% vs June 2019. July may even be better and I expect to reach to preCovid numbers by Oct 2020.

Are patients still showing reluctance to come to the CVL?

Few pts still are enquiring about the issues of Covid exposure but majority understand that extra precautions to avoid Covid exposure are being done strictly.

Are you verifying their Covid-19 status?

Yes we are checking all pts for Covid-19 antigen PCR test of Roche Cobas 800 series.

By which test?

Covid Antigen Roche PCR test is routine and not the Covid antibody.

Are interventional cardiologists being tested for Covid antibodies?

Yes all MSH staff have been tested for Covid-19 antibody but incidence of antibody+ in asymptomatic staff was only 2.2%.

Has STEMI volume begun picking up?

STEMI volume is still very low; 1 per week instead of 3-4 per week in pre-Covid era.

Maximal PPE for each case or any relaxation?

Absolutely no relaxation on the PPE use in each case based on the Covid status.

What Covid precautions can be taken for the patients in holding area, before and after the procedure?

Covid precautions will be; 1) check for symptoms and fever before or on arrival; 2) constantly disinfecting all the surfaces; 3) facial covering all the times; 4) 6 feet separation of chairs and beds; 5) keeping all Covid+ pt’s or PUIs in a separate unit not mixing with Covid- pts.

How would Orbital Atherectomy have fared in today's case?

Orbital atherectomy would have been suboptimal in this DES ISR CTO and RA was most optimal. RA has an edge over OA in unexpanded stents likely due to the heat generation by RA, modifying the hard plaque behind the stent struts.


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2 thoughts on “Imaging Guided PCI of DES CTO RCA – July 2020”



  2. Dr.Hanna Al-Makhamreh says:

    Underexpanded stent

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