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Case summary

Patient: male 77 y

Dyspnea and angina since several months

NSTEMI 26.11.16

3 vessels disease:  several stenosis LAD, CX and RCA

 culprit lesion LAD (with thrombus)

CTO IM branch und PD of RCA

Syntax score:  28

LVEF:      45%

Inferior and apikal akinesia

No valvular heart disease

Renal function:  eGFR = 85 ml/min/1.73m2

CVRF:  aHT, dysplidemia

How to treat this patient?

Syntax score: 28

EuroSCORE II:  2.2

STS-score:  1.2 for mortality

    9.4 for morbiditiy and mortality

Proposed treatment:   CABG, but patient refused

Todays planned procedures:

PCI of the LAD and diagonal branch

Ev. RCX PCI

Protocol

OptiRAY® (Ioversol)

Concentration 300 mgI/mL

Flow rate: 3.5 mL/ s

Volume: 112 mL

Total exposure : 0.8 Gy

Exposure time: 27 minutes

15 images / s low dose Philips

57 images mostly fluoro

 

Shooting date : 2016-11-03
Last update : 2021-06-09
Daniel Weilenmann
St. Gallen, Switzerland

OptiRAY® / Guerbet

Optiray® contrast agent is lower osmolar, lower viscosity and nonionic.
2 comments
Join the Discussion
  • Alexander P. Why DES in distal LAD ? BVS Absorb?

    • Daniel W. Hi Alexander. Thank you for your question. We know from the Absorb data that scaffolds perform worse than DES in smaller vessels, associated with a higher MACE rate. An alternative could be treating small vessels with DCB. The BASKET small study result will be presented in 2018 (DES vs DCB in small vessels). DCB are good in our experience when you have TIMI flow III, no more than a dissection A or B, and less than 30% residual stenosis.

    Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
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