1. Dr Hossam Ismail
Lecturer of Cardiology
Qena Faculty of Medicine
South Valley University ,Egypt
High thrombus burden in Non target vessel
2. I have no relevant financial relationships
*72ys old male presented with syncope lasting for few seconds .
*The patient sought neurological consultation that revealed no
apparent neurological cause of syncope
*After cardiac evaluation of our patient .
*His examination was within normal value
*ECG :- definite pathological Q wave in ant. Chest lead
3. Echo :- A kinetic apex .severe hypokinesia in ant wall ,hypokinesia inf. wall
,dilated LV , mild dilated Lt atrium with impaired LV systolic function &EF
=40%.
Myocardial perfusion imaging was +ve to LAD territory.
Coronary angiography reveal –
1)Osteal chronic total occlusion (100%) of LAD with good retrograde
recanalization from RCA
2)Normal LCX
3)Mid segment RCA lesion (90%)
So ,Our strategy to start PCI to LAD with
Ante grade approach using contralateral injection .
4. *By using micro catheter and stiff wire we can passed to the LAD successfully and by
using different balloon size the LAD opened and also good size 1st diagonal branch
that started to open this diagonal branch .
*During our work the patient suffered from severe chest pain with marked
hypotension and dynamic ECG changes.
*After check what is happened we noticed huge thrombus appeared at the ostium of
LCX that unfortunately occlude the vessel in multi VD pt.
*Immediately passing wire to LCX trying to open the vessel and we did . And we
removed big thrombus by using thrombus aspiration catheter and using different sized
balloon .
*Fortunately ,the flow to LCX was restored leaving distal thrombus and our patient
was stabilized with improved pain and maintained the hemodynamic of the patient
5. *At this point ,we decided to stop our procedure and leaving our patient to medical TTT and
redo in another session .
*After 2 hours ,some colleague suggest to check LCX distal thrombus and give a look to LAD
.
*So ,we decided to redo our patient and trying to re open the LAD &passed the same wire
smoothly and then we stented LAD by using 2 long DESs with good results and TIMI III flow
*And then we passed a wire to the LCX then along the wire we passed the different balloon
size to crush the distal thrombus leaving very minimal haziness to the very distal LCX with
TIMI III flow .
*The patient discharged with very good clinical condition
*His clinical follow up after 6ms with improved LV systolic function reaching about 50%.
With symptoms free.
6. Take home massages
1.Try to be simple and try to continue your work as
you arranged pre-cath .(as regard opening the diagonal
branch)
2.Please don’t forget repeating check to ACT in long
procedure.
3.Be ready with your weapons against any
complication.
4. Please respect the complaint of your patient &keep
your eyes open to the hemodynamic of the patient
5.Continue your work later on after stabilization of
your patient.
7. High thrombus burden in Non target vessel
Dr Hossam Ismail
Lecturer of Cardiology
Qena Faculty of Medicine
South Valley University ,Egypt
9. *72ys old male presented with syncope lasting
for few seconds .
*The patient sought neurological consultation
that revealed no apparent neurological cause of
syncope
*After cardiac evaluation of our patient .
10. *His examination was within normal value
*ECG :- definite pathological Q wave in ant. Chest lead
*Echo :- A kinetic apex .severe hypokinesia in ant wall
,hypokinesia inf. wall ,dilated LV , mild dilated Lt atrium
with impaired LV systolic function &EF =40%.
*Myocardial perfusion imaging was +ve to LAD
territory.
11. Coronary angiography reveal –
1)Osteal chronic total occlusion (100%) of LAD with
good retrograde recanalization from RCA
2)Normal LCX
3)Mid segment RCA lesion (90%)
So ,Our strategy to start PCI to LAD with
Ante grade approach using contralateral injection .
12.
13.
14.
15.
16.
17.
18. *During our work the patient suffered from
severe chest pain with marked hypotension and
dynamic ECG changes.
*After check what is happened we noticed huge
thrombus appeared at the ostium of LCX that
unfortunately occlude the vessel in multi VD pt.
19.
20.
21. *At this point ,we decided to stop our procedure
and leaving our patient to medical TTT and redo
in another session .
*After 2 hours ,some colleague suggest to check
LCX distal thrombus and give a look to LAD
22.
23.
24. *The patient discharged with very good clinical
condition
*His clinical follow up after 6ms with improved
LV systolic function reaching about 50%. With
symptoms free.
25. Take home massages
1.Try to be simple and try to continue your work as you
arranged pre-cath .(as regard opening the diagonal
branch)
2.Please don’t forget repeating check to ACT in long
procedure.
3.Be ready with your weapons against any complication.
4. Please respect the complaint of your patient &keep
your eyes open to the hemodynamic of the patient
5.Continue your work later on after stabilization of your
patient.
*By using micro catheter and stiff wire we can passed to the LAD successfully and by using different balloon size the LAD opened and also good size 1st diagonal branch that started to open this diagonal branch .
*Immediately passing wire to LCX trying to open the vessel and we did . And we removed big thrombus by using thrombus aspiration catheter and using different sized balloon .
*Fortunately ,the flow to LCX was restored leaving distal thrombus and our patient was stabilized with improved pain and maintained the hemodynamic of the patient
*So ,we decided to redo our patient and trying to re open the LAD &passed the same wire smoothly and then we stented LAD by using 2 long DESs with good results and TIMI III flow
*And then we passed a wire to the LCX then along the wire we passed the different balloon size to crush the distal thrombus leaving very minimal haziness to the very distal LCX with TIMI III flow .
