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NSTEMI

Sapien 3

Case 8 – Complex Multivessel PCI

Case Presentation

  • An 87-year-old woman presented with recurrent left sided chest pain and found to have NSTEMI.
  • Coronary angiogram revealed 99% ostial LCx disease, 95% ostial D1 with moderate LM disease.
  • Medical history: CAD s/p multiple rota-PCIs, Severe AS s/p TAVR, Paroxysmal atrial fibrillation on Coumadin, Factor V deficiency, Hypertension, Hyperlipidemia, CVA.
Selective LCA engagement was performed by using VL 3.5 guide catheter in a usual fashion.
Angiogram showed severe ISR with 99% ostial LCx and 95% ostial D1 disease.

PCI Strategy

  • Given the presence of severe ostial bifurcations lesion in LCx and D1, patient was offered to undergo CABG.
  • Patient refused CABG and preferred to undergo percutaneous intervention.
  • Plan for laser atherectomy +/- stent placement.
  • Intracoronary imaging to access the etiology of ISR.
  • Laser atherectomy of LCx was performed using 0.9 mm catheter (Spectranetics, Colorado Springs, Colorado) using maximal pulse frequency of 80 Hz and maximal fluency of 80 mJ/mm.2
IVUS of LCx revealed severe neointimal hyperplasia with MLA of 2.7mm.2

IVUS

Cutting balloon angioplasty was performed by using wolverine 3.25/6 in proximal LCx and D1.
There was significant plaque shift to LAD after CB-PTCA of LAD-D1 and kissing balloon inflation was performed with an excellent result.

Final angiogram

Learning Points

  • The standard catheters (such as VL 3.5, EBU 3.5, FL 4) can be used to engage the coronary artery in patient with post TAVR – Edward Sapien valve (balloon-expandable).
  • If difficulty in engagement, we could rail the guide catheter toward the ostium using coronary guidewire or J wire.

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.

Left Main DK Crush Video ID