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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.

ModelBurst (ATM)Diameter (mm)Balloon Length (mm)              
681215202530
MINI TREK (CTO INDICATED)1.271.2
1.561.5
2.172✓*✓*
TREK2.372.25
2.672.5
2.912.75
3.113
3.53.25
3.73.5
3.943.75
4.324
4.864.5
5.365
*Only available as RX, not as OTW. Other sizes available in both versions.
Retrieved on April 07 2022 from Abbott product ordering information. Please look at the company's files for the latest available data on device configurations and avilability in your area.

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