Case 7 – LM/LAD PCI
- A 77-year-old woman with medical history of CAD s/p PCIs, severe aortic stenosis s/p TAVR (29 mm Evolut Pro) presented with angina like chest pain for last few days. Ruled in as NSTEMI with peaked troponin of 29.95 ng/ml.
- EKG showed T wave inversion in antero-septal leads. ECHO showed normal LVEF with normal gradients across aortic valve.
First, JL 3.5 catheter was used but not able to do selective engagement. Then, FL 3.0 and Ikari right 1.0 were changed to engage LCA without success.Left coronary angiogram was done by using Ikari right 1.5 and showed significant disease in distal left main and proximal LAD.
- In post TAVR cases, it is helpful to have step by step guide catheter selection for coronary angiogram, like in this case. (JL 3.5> FL 3.0> Ikari 1.0> Ikari 1.5)
- Operator should expect that it could sometimes require multiple catheters to engage coronary artery in post TAVR patient.
- Railing the guide catheter towards the ostium (for selective engagement) using guide wire or J wire is particularly useful in post TAVR case.