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11:55 CASE 9 - Reimers

Experts "Live" CTO Workshop 2014
25th Septemper 2014 in Madrid, Spain

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11:55 CASE 9 - Reimers

  1. 1. when things might go wrong, usually they do (reverse murphy law technique) bernhard reimers andrea pacchioni Mirano
  2. 2. BRIEF INTRO: the patient Male, 57 yrs old Active smoker, Hypertension, Dyslipidemia 2012: NSTEMI • 80% mid LAD PCI w DES • 100% prox RCA unsuccesfull antegrade LVEF 54% optimal medical therapy (DAPT – β blocker – ACEI – statin - nitrates) 2013: positive stress test @ mid level
  3. 3. July 2013: diagnostic coronary angiography
  4. 4. strategy? • Pump up medical therapy: add ivabradine/ranolazine • RCA CTO: antegrade again fix LM and then retrograde Blunt stump Big side branch Good septal collaterals
  5. 5. dye amount: 250 ml (iodixanol 320) fluoroscopy time: 26’ radiation: 216090 milligray/cm2 in cath lab: 8 am to 10.15 am introducers: 2 terumo destination 8 fr 45 cm guiding cath: AL 1.5 SH asahi hyperion 8 Fr & Cordis XB 4 8 Fr wires: asahi sion - sion blue - abbott bmw microcath: Asahi corsair 150 cm stent: abbott xience V 3.5 - 18 mm balloons: quantum 3.5 - 15 mm coils: 2 vortx 3 - 2.5 mm ivus: Volcano
  6. 6. follow up hs troponin peak 82 ng/l hospital stay: 4 days minimum pericardial effusion @ echo (completely resolved before discharge) telephone FU: fine, living in sardinia, asymptomatic (ivabradine added)
  7. 7. what we learned keep the entire screen (do not focus only on coronaries) look for complications (also where you do not expect any) have a panic box with inside: pericardiocenthesis set - coils - fast echo - covered stent

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