Dyspnea on Exertion
Case 3 – LM Rota/PCI
- An 83-year-old male presented with dyspnea on exertion and leg swelling.
- Nuclear stress test showed moderate to severe lateral and posterolateral ischemia, mild inferior ischemia with partial scarring.
- Cardiac history: CAD (s/p CABG x 3 in 2006 : LIMA > LAD, SVG > D1 (occluded) jump to OM1, SVG > RPDA (patent), Severe AS s/p TAVR on 2/13/15, and CHB s/p PPM.
- Coronary angiogram revealed 3 vessels and left main disease with occluded SVG to LAD-D1-Jump OM1 and patent LIMA to mid LAD, SVG to RPDA.
- ECHO revealed LVEF of 65% and normal functioning bioprosthetic aortic valve with mild to moderate AR.
- With the presence of occluded vein graft to LAD-D1 and OM1, planned to perform PCI to left main disease.
First, left coronary angiogram was attempted by VL 3.5 without success. Then, FL 3.5 guide catheter was used but the catheter was being directed into the inferior part of the left coronary system.
Then, we changed to FL 3 guide catheter and successfully engaged by railing the catheter over the J-wire.
- Multiple guide catheters may sometimes require to perform coronary angiogram and intervention. This case had used VL 3.5 > FL 3.5> FL 3.0 > EBU 3.0.
- EBU 3.0 was used for a better support although FL 3.0 was successfully engaged.
- If necessary, selective coronary engagement can be done by railing the guide catheter over the J wire.