Case 6 – Thrombotic LAD PCI
- An 88-year-old male with medical history of Severe AS s/p TAVR (34 mm Evolut-R ), CAD s/p PCIs, and HFpEF presented with angina pectoris.
- EKG showed an old LBBB but new ST elevations in the lateral leads. Trop was positive with peaked level of 164.
- TTE showed apical and septal hypokinesis with LVEF 35%.
FL 3.5 catheter was then used for left coronary angiogram but not able to do selective engagement. Then we attempted by advancing the coronary guide wire first , then railed VL 3 guide catheter over the wire for selective engagement.
A guide extension catheter (i.e. Guidezilla) was used for a better support. The angiogram revealed a thrombotic lesion in proximal LAD.
- The catheter choice in post TAVR (EVOLUT valve) is usually FL 3.0/3.5, followed by Ikari right 1.0/1.5.
- VL 3 guide catheter can sometimes be used for selective engagement.
- The operator should have a low threshold to use guide extension catheter in post TAVR PCI cases.