View
2
Download
0
Category
Preview:
Citation preview
Acute Thrombotic Occlusion as a Complication of Functional Flow Reserve Measurement(FFR)Measurement(FFR)
Department of Cardiology Saga Prefectural Hospital Koseikan Saga Japan Saga Prefectural Hospital, Koseikan, Saga, Japan Arihide Okahara, Daigo Mine, Takaharu Shirahama,
Y t N t T t Shi i K iki Y hidYasutsugu Nagamoto, Tetsuya Shiomi, Keiki Yoshida, Kenji Sadamatsu
CASE
Age, Sex 76y.o. male
Chief complaint Chest pain at effort
Social history Non smoking or drinkingSoc a sto y
Family history Nothing paticular
Non smoking or drinking
Family history Nothing paticular
Past medical history Internal hemorrhoids Occasional bloody stool.y
Hi t f t illHistory of present illness
•He was admitted to our hospital for effort angina.
•He was underwent balloon angioplasty for the mid portionof the left anterior descending artery 16 years ago.of the left anterior descending artery 16 years ago.
•His coronary risk factors were hypertension anddyslipidemiadyslipidemia.
•The ECG and the echocardiography were normal.
•Thallium myocardial scintigraphy showed a reversible largesized perfusion defect in the LAD territory.sized perfusion defect in the LAD territory.
Left coronary angiography y g g p y
RAO-CAU RAO-CRARAO CAU RAO CRA
Severe stenotic lesions in the proximal LCx and the proximal LAD.
Right coronary angiographyg y g g p yLAO
A severe stenosis in the proximal RCA p
FFR to the LAD
We planned to evaluate FFR in all the 3 arteries toWe planned to evaluate FFR in all the 3 arteries to decide a treatment strategy.
After the calibration and the equalization of the qpressure wire,we inserted the wire in LAD through a 5-Frenchwe inserted the wire in LAD through a 5 French diagnostic catheter.
FFR to the LAD
FFR in the distal LAD FFR in the LMT
The waveform (red line) obtained through the diagnostic catheter ( ) g gwas damped.
LCAG after FFR
When we changed the catheter, he complained chest pain g p pand his ECG showed ST elevations in II, III, aVF, V5-6 leads, and ST depressions in I, aVL, V1-4 leads. LCAG revealed a total occlusion in the proximal LCX and the obtuse marginal artery.
PCI to the LCX
Guiding catheter: a 6-French BL3.0 Guide wire:Runthrough NS hypercoartg ypIVUS: Atrantis pro2
IVUS
10
IVUS Thrombus
11
PCI to the LCX
IVUS showed fibrous plaque and thrombus, without dissection or plaque rupture. B ll S i t L d 3 0 15
12
Balloon : Sprinter Legend: 3.0 x 15 mm
PCI to the LCX
Balloon angioplasty with a 3.0 x 15 mm balloon recovered
13
g p yTIMI grade 3 flow .
PCI to the LCX
The obtuse marginal artery remained occluded, then we inserted another floppy wire.
14
Guide wire: Sion blue
PCI to the LCX
We dilated the lesion with the balloon.Balloon: Sprinter Legend: 3.0 x 15 mm
15
p g
PCI to the LCX
The flow was not recovered, then we inserted a thrombectomy
16
, ycatheter.
PCI to the LCX
We successfully retrieved a large thrombus.
17
PCI to the LCXThe final LCA angiogram
Final angiogram showed a good result.
Time table
0 min •Dose of hepaine: 2000 units0 min
2 min
•Dose of hepaine: 2000 units
•LCAG2 min
4 min
•LCAG
•RCAG4 min
35 min
RCAG
•ATP start35 min
45 min
ATP start
•ST elevation45 min
73 min
ST elevation
•Aspiration of thrombus73 min
84 min
Aspiration of thrombus
•The end of PCI8 e e d o C
Take Home Messageg
•Give appropriate dose of heparin before FFR.
•Be careful for the waveform during FFR.
Recommended