PCI for a Patient with Multivessel Disease and Renal

Transplantation--- Case Report

Zhang Qi, MDRuiJin Hospital

Shanghai Jiaotong University School of Medicine

Case Introduction• Male, 70y• OMI (ant), SAP, HBP• Previous MI : Jan, 2000• Other history : renal transplantation due to

10ys of chronic renal failure in 2007• EKG: Q wave in anterior leads (V1-4)• UCG: LVEF 0.41• Serum Cr 108umol/L (1.22mg/dl), estimated

Ccr=58.6

CAG Results2010-1-28

Interpretation and StrategyMultivessel disease with

compromised LV function

CABG PCI

• Renal Status: Cr 108umol/L, three years after renal transplantation

• Medication: still on anti- rejection regimen (predinisone and CTX)

LAD: Succeed

LAD: Fail

Partial Revascularization w/ PCI & medication

Medication only

Renal Function Consideration

• Estimated maximal contrast consumption• 73.5kg in body weight, with baseline Cr

108umol/L• MRCD=301ml• Hydration strategy • Iso-osmolar contrast

PCI for LAD

7F EBU 3.75 G.C.Finecross Microcatheter + Miracle 3.0

Double Wires: Miracle 3.0/4.5“4.5 in microcatheter”

PCI

Change to Pilot 150 in microcatheter, Micracle 3.0

into diagonal area

Pilot 150 failed to reach the LAD middle true lumen, but

Micracle 3.0 placed into distal diagonal branch

PCI

Strategy changed to predilate the diagonal first with a 1.25x15mm balloon

PCI

Re-efforts in LAD, with Conquest-pro wire

True lumen placement, proved by multiple projections

PCI

Predilate LAD with 1.5x15mm Apex-Push Balloon

True lumen position of Conquest wire re-confirmed

PCI

Predilate with 2.0x20mm Balloon After predilatation, and stents were ready

PCI

3.0x36mm SES

16atm

3.5x33mm SES

16atm

Final Results of LAD PCI

Post-dilate with 3.5x33mm stent balloon @ 18atm

Final Results

Temporary Conclusions• 2hours, 400ml contrast (iso-) consumption• Both doctors and patient are tired• Elective PCI for RCA and LCX was

planned • Hydration strategy was applied before PCI

and continued for 12hours after PCI, with 1ml/kg/h NS intravenously infusion

Elective PCI for RCA & LCX2010-2-23

PCI for RCA & LCX

3.0x36mm SES 2.75x23mm SES

30 minutes and 100ml contrast consumption !

Renal Function Monitoring

Cr.(umol/L)

BUN(mmol/L)

2010-1-26 108.0 9.1

2010-1-29 113.0 6.8

2010-2-9 106.0 7.2

2010-2-20 102.0 8.1

2010-2-25 97.0 6.7

Take Home Messages• In CAD patients with co-morbidities, including severe

noncardiac conditions (renal, lung), CABG may be

contra-indicated.

• PCI may leave to be the only choice to improve

survival status.

• Advances in PCI for CTO lesions: equipments (wires,

microcatheter,etc) , techniques (retrograde, multiple

wires, etc.)

Take Home Messages • In some circumstance in CTO PCI, wire is easy

to reach the branch vessel distal to occlusion, and predilate the branch distal to occlusion may help to reach the main vessel by another wire.

Thanks