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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.

Left Main DK Crush Video ID