11:55 case 9 - reimers

10
when things might go wrong, usually they do (reverse murphy law technique) bernhard reimers andrea pacchioni Mirano

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Page 1: 11:55 CASE 9 - Reimers

when things might go wrong, usually they do (reverse murphy law

technique)bernhard reimersandrea pacchioni

Mirano

Page 2: 11:55 CASE 9 - Reimers

BRIEF INTRO: the patient

Male, 57 yrs oldActive smoker, Hypertension, Dyslipidemia2012: 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

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July 2013: diagnostic coronary angiography

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strategy?

• Pump up medical therapy: add ivabradine/ranolazine

• RCA CTO: antegrade again

fix LM and then retrograde

Blunt stumpBig side branch Good septal collaterals

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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

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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)

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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