Plaque Shift

1,840 views
1,736 views

Published on

A case presentation of plaque shift

Published in: Health & Medicine, Technology
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,840
On SlideShare
0
From Embeds
0
Number of Embeds
7
Actions
Shares
0
Downloads
22
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Plaque Shift

  1. 2. CASE PRESENTATION By Dr. Khalid Iqbal Bhatti Post Fellow
  2. 3. Sequence <ul><li>Introduction </li></ul><ul><li>Clinical History </li></ul><ul><li>Clinical Examination </li></ul><ul><li>Labs </li></ul><ul><li>Images </li></ul><ul><li>Discussion </li></ul><ul><li>Follow-up </li></ul>
  3. 4. Clinical History <ul><li>52 Years </li></ul><ul><li>Known case of diabetes mellitus for 14 years </li></ul><ul><li>Know case of hypertension for 1 year </li></ul><ul><li>Non smoker </li></ul><ul><li>Non Asthmatic </li></ul><ul><li>No previous History of IHD </li></ul>
  4. 5. Clinical History contd… <ul><li>Chest pain/heaviness for 3 to 4 hours radiating both arms relieved by nitrates </li></ul><ul><li>During admission pain recurred </li></ul><ul><li>Associated with sweating </li></ul>
  5. 6. Clinical Examination <ul><li>Pulse 72 beats/min </li></ul><ul><li>BP 110 / 70 mmHg </li></ul><ul><li>RR 22 breaths/min </li></ul><ul><li>CVS Unremarkable </li></ul><ul><li>ECG ST depression in V2 – V5 </li></ul>
  6. 7. Labs <ul><li>Troponin less than 0.05 ng/ml </li></ul><ul><li>Routine investigations Normal </li></ul>
  7. 8. Summary <ul><li>52 yrs present with USA having multiple risk factors and ECG changes </li></ul><ul><li>Recommended for Coronary cath </li></ul>
  8. 9. Images <ul><li>Coronary Angiography </li></ul>
  9. 10. Discussion <ul><li>Plaque shift </li></ul><ul><li>The lateral dislocation of plaque during dilatation therapy, which if directed towards a side branch, may occlude the ostium </li></ul><ul><li>Snow-plow injury </li></ul><ul><li>a form of plaque shift that occurs at the carina of the bifurcation where plaque is dislocated from the parent vessel into the ostium of the side branch </li></ul>
  10. 11. Predictors  of  side  branch   occlusion <ul><li>Several mechanisms are responsible for SB compromising during bifurcation treatment: </li></ul><ul><ul><li>Plaque shift “snow plow effect ” </li></ul></ul><ul><ul><li>Dissection of SB after balloon/stent in MB </li></ul></ul><ul><ul><li>Spasm of SB </li></ul></ul><ul><ul><li>SB ostium jailing by stent struts </li></ul></ul><ul><ul><li>Carina stent-induced displacement </li></ul></ul>
  11. 12. Characteristics of bifurcation lesions PCI
  12. 13. Identification of Side Branch at risk
  13. 14. Identification of Side Branch at risk <ul><li>SB Occlusion during PCI </li></ul>
  14. 15. Plaque Shift At Bifurcation Lesions <ul><li>PCI of Bifurcation lesion is challenging </li></ul><ul><li>Side-branch compromise in 9-67% of cases </li></ul><ul><li>Protection of side branches is time consuming, associated with more contrast media, radiation, and increased risk of complications as dissection, perforation, CIN </li></ul><ul><li>In bifurcation lesions in which there is no significant involvement of the side branch, we cannot predict the fate of the side-branch after PCI </li></ul>
  15. 16. Plaque Shift At Bifurcation Lesions <ul><li>Intra-coronary near-infrared spectroscopy can identify lipid-core plaques using the Lipiscan (InfraRedx) system </li></ul><ul><li>Lipid-core plaques are soft, and prone to plaque shift during PCI </li></ul><ul><li>Side-branch compromise as a result of plaque shift is associated with increased rate of peri-procedural MI and other complications </li></ul><ul><li>Near-infrared spectroscopy can potentially help to identify bifurcation lesions that are in increased risk of side-branch compromise </li></ul>
  16. 17. <ul><li>Both plaque shift from the MB and carina shift contribute to the creation / aggravation of a SB ostial lesion after MB stent implantation. </li></ul><ul><li>The mechanism of side branch(SB) luminal narrowing after main branch(MB) stent implantation in coronary bifurcation lesions is not completely understood. </li></ul>
  17. 18. Management / Protection <ul><li>Accurate stent positioning </li></ul><ul><li>Protect side-branch with wire </li></ul><ul><li>Nitrates to exclude spasm </li></ul><ul><li>Kissing PTCA to side-branch </li></ul><ul><li>Stent occasionally required </li></ul><ul><li>IVUS </li></ul>
  18. 19. Follow-Up <ul><li>Clinically </li></ul><ul><ul><li>No symptoms </li></ul></ul><ul><ul><li>No serial ECG changes </li></ul></ul><ul><ul><li>Vitally stable </li></ul></ul><ul><ul><li>Observe for 24 hours </li></ul></ul><ul><ul><li>Glycoprotein IIb / IIIa inhibitor </li></ul></ul>
  19. 20.
  20. 21. THANKS

×