Case 11: Thrombotic Lesion (STEMI)
Case Presentation
- A 72-year-old man presented with acute onset of chest pain and shortness of breath.
- Found to have ST elevation in inferior leads and then cardiac catheterization lab was activated for emergent LHC.
- Medical history: HTN, HLD, Ex-smoker
- Medication : Lisinopril 20mg, Atorvastatin 20mg
- Coronary angiogram showed 70-80% stenosis in pLCx with mild disease in LAD, acute thrombotic occlusion in distal RCA.
Angiogram
Angiogram
- In a setting of STEMI, we could use any workhorse wire which has a soft tip with hydrophilic or coated property (i.e. Runthrough, Sion Blue).
- Sion Blue was used here and advanced to the distal RCA without any difficulty.
- One DES (Promus Elite 3.5/38) was placed in dRCA with good result.
Learning Points
- The objective in STEMI/acute thrombotic occlusion is to cross the lesion and advances the wire to the distal lumen softly and atraumatically.
- Any workhorse wire can be used in this situation. (i.e., Runthrough, Sion Blue).
- In subacute occlusion, it may sometimes require a stiffer tip and higher tip load to facilitate the crossing, such as Fielder or Gaia series.
