Onyx in post-CABG & post-PTCA patient with distal LMCA edge stenosis of stent
Case presentation
- 74 Year old Male patient appeared with recent onset of Angina.
- 1996 – CABG
- 2003 – LIMA to LAD occluded – AWMI – PTCA to osteal LAD [Penta stent]
- 2013 – Unstable angina – DE novo lesion of Mid LAD – PTCA [Resolute Endeavor]
- 2018 – Distal LMCA edge restenosis across the LCX, Patent R. Endevour stent. Osteal LCX 80% stenosis, OM diffuse disease, RCA mid segmet CTO.
- LIMA to LAD & SVG to OM Occluded. RIMA to RCA patent & post anstomosis PDA signicant stenosis.
- ADVICE – Redo CABG but refused by patient in view of high risk.
Diagnosis and treatment planÂ
- Echo showed LV RWMA+ of LAD territory, FAIR LV function.
- Diagnosis: CAD –ACSNSTEMI, HTN+, Dyslipidemia.
- Procedure: PTCA 2 Stents to LMCA – Minicrush or DK crush
- Location: LMCA, LAD, LCX.
- Lesion Severity: Calcified, LAD osteal stent, High risk procedure.
cag: sigificant stenosis of lmca across the lcx with stenosis of osteal lcx.
lmca to lad crossover stenting using r.onyx stent 3.5* 30 mm across the lcx
final image: successful done ptca lmca
Resolute onyx: how it made my case easy?
- Onyx showed excellent outcome in LMCA. There were no signs of residual stenosis or any edge dissection found. The final result was TIMI 3 flow.
- No occlusion or stenosis of LCx ostium – no plaque shift or carina shift.
- High risk angioplasty in unstable crashing patient made simple.
- Easy tracking of stent in calcified, restenosed LM-LAD lesion.
Conclusion
- The final result was good with TIMI 3 flow & no residual stenosis or dissection
- Provisional stenting is always a better option in such an unstable patient to bailout his symptoms.
- IABP should be standby option.
About Author –
Dr. Pankaj Vinod Jariwala, Consultant Interventional Cardiologist, Yashoda Hospitals - Hyderabad
MD, DNB (Cardiology)
