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Case 23: Simple Lesion

Case Presentation

  • A 60-year-old man presented with new onset left sided chest pain on exertion and relieved by rest. Stress MPI showed mild-moderate anteroseptal and inferior ischemia. Echocardiogram showed normal LVEF with 56%.
  • Medical History: Hypertension, Hyperlipidemia, End-Stage renal disease on hemodialysis, Ex-smoker
  • Medications: ASA 81mg daily, Amlodipine 10mg daily, Carvedilol 3.125mg BID, Hydralazine 25mg TID

Angiogram

Angiogram

PCI Strategy

  • The coronary angiogram showed a significant disease in ramus artery with 80-90% stenosis.
  • Since the lesion is not calcified or tortuous, it can be classified as ACC/AHA Type A lesion (simple lesion).
  • Plan to use workhorse wire, followed by predilation and stent placement.

STEPS

  • We used VL 3.5 guide catheter (Mach 1: Boston Scientific).
  • For Type A lesion, we can use any workhorse wire which has a soft tip with hybrid coating (hydrophilic coating with distal hydrophobic coating) (i.e. Runthrough, Sion Blue).
  • We used Runthrough to cross the lesion, followed by predilatation using Trek NC 3/12mm balloon.
  • Then, Xience Sierra 3.25/18mm was placed in the ramus artery followed by post-dilatation using Trek NC 3.5/12 mm balloon.
  • A final angiogram showed an excellent result.

Learning Points

  • In Type A lesion intervention, the goal is to cross the lesion and advance the wire to the distal lumen softly and atraumatically.
  • Any workhorse wire can be used per the operator’s preference to perform the coronary intervention.

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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