How should I treat complex anatomic lesions and manage complications?

Program

Cases in box: Clinical Data

• Case in box n°1: Complex PCI in MVD (Rotablator)
  • Male, 78 years old
  • No CAD known
  • Since 3 weeks angina pectoris CCS II
  • No concomitant diseases known
  • CVRF: hypertension, dyslipidemia
  • 11.9.17 admitted for NSTEMI with intermittent angina
  • CAG 11.9.17: very calcified vessels, proximal LAD 50.70%, eccentric, mid LAD 95% (culprit lesion), CX proximal 50%, marginal 80%, RCA with severe stenosis ostial stenosis, mid RCA with severe stenosis
  • Echo: normal, LVEF 65%; mild aortic stenosis
  • Renal function: eGFR = 55 ml/min/1.73m2
    
    
    
     
• Case in box n°2: CTO of mid RCA
  • Male, 62 years old
  • No CAD known
  • Check up showed a pathologic ECG, asymptomatic
  • Cardiologist found a slight inferior hypokinesia
  • Stresstest: significant ST depression, no angina
  • No concomitant diseases known
  • CVRF: smoker (70py), hypertension, dyslipidemia, family history
  • Sent for CAG
  • CAG 24.8.17:proximal LAD 50%, D1 and D2 50%, CX without stenosis, dominant with occlusion of the mid part
  • J-CTO score: 1
    
    
    
     
• Case in box n°3: LAD PCI with a self apposing stent
  • Male, 44 years old
  • No CAD known
  • Since 3 weeks angina, in the last days clas IIII
  • T-inversions in the V1-V6
  • Echo: normal LVEF 65%, inor regional dysfunction
  • CVRF: family history, dyslipidemia, former smoker
  • Renal function: eGFR =>90 ml/min/1.73m2
  • CAG: tight stenosis of the proximal LAD, intermediate stenosis of mid LAD, intermediate stenosis of the CX
    
    

• Case in box n°4: In stent CTO post CTO PCI mid RCA
  • Male, 54 years old
  • 2005 CTO PCI of the RCA with DES
  • 2011 CTO PCI of the LAD with DES
  • Asymptomatic for several years
  • No concomitant diseases known
  • CVRF: former smoker (10py), hypertension, dyslipidemia, IDDM
  • Echo: LVEF 65%, normal
  • MRI: Normal LVEF, full viability, large inferior ischemia
  • Renal function: eGFR = 93 ml/min/1.73m2
  • Since 3 months angina pectoris CCS II
  • SPECT with inferior ischemia. Sent for CAG
  • CAG 5.9.17: LAD 50% with good result in DES, CX without stenosis, in-stent reocclusion of the RCA
  • J-CTO score: 1
    
    

Educational objectives

• Improve coronary angioplasty knowledge (techniques and approach strategies).
• Discuss the choice of a material.
• How to manage complications.
• Compare techniques and approach strategies of different experts.