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A 77-year-old man presented with non-STEMI. Cardiac catheterization on August 30, 2011 revealed 3-vessel CAD (95% ostial RCA, 50% distal LM, 70% to 75% multiple lesions in LAD, and 70% OM2) and near-normal systolic LV function. Patient underwent PCI of culprit RCA vessel using Xience® V DES. The patient now has crescendo angina and the treatment plan is for FFR-guided PCI of LAD and/or LMCA.
An 86-year-old woman with prior DES PCI of mid-LAD presented with CCS class IV angina. Cardiac catheterization on October 21, 2011 revealed 3-vessel CAD and normal LV function and new culprit 90% lesion in distal LAD. Patient underwent PCI of distal LAD using Xience® V DES. The treatment plan now is for rotablation and DES for complex calcified ostial and distal RCA lesions.
PARTNER, RIFLE, TWENTE, transcatheter valves, novel DES, and renal denervation — Drs. Worthley and Meredith give their take on the hot topics for the interventionalist.
A 72-year-old woman who had 2-vessel CABG in 1985 presents with angina (CCS class III) and high-risk findings on a stress MPI for multivessel ischemia. Cardiac catheterization on June 6, 2011 revealed 3-vessel + LM CAD, patent LIMA to LAD with 90% lesion in native LAD after anastomosis, patent SVG to RCA, and 95% lesion in native LPL. LVEF is 60%. The patient underwent PCI of LM and LPL using Promus® DES. The treatment plan now is for staged PCI of the native LAD via LIMA.
A 72-year-old woman who had 2-vessel CABG in 1985 presents with angina (CCS class III) and high-risk findings on a stress MPI for multivessel ischemia. Cardiac catheterization on June 6, 2011 revealed 3-vessel + LM CAD, patent LIMA to LAD with 90% lesion in native LAD after anastomosis, patent SVG to RCA, and 95% lesion in native LPL. LVEF is 60%. The patient underwent PCI of LM and LPL using Promus® DES. The treatment plan now is for staged PCI of the native LAD via LIMA.
A 68-year-old man with prior PCIs in 1999 has crescendo angina and high-risk stress MPI for multivessel ischemia. Cardiac catheterization revealed calcified distal left main and circumflex disease (SYNTAX Score 16) and moderate LV dysfunction (LVEF 40%). The treatment plan now is for PCI of the unprotected left main coronary artery.
A 51-year-old man with prior PCIs in 2004-2006 presented with crescendo angina and high-risk stress echocardiogram for multivessel ischemia. Cardiac catheterization revealed 2-vessel CAD (95% proximal LAD; TAXUS® DES ISR and 80%-90% calcified mid-RCA with distal branch diseases). Patient underwent atherectomy using AngioSculpt® balloon and re-DES using XIENCE V® of proximal LAD. The treatment plan now is for complex PCI of mid-RCA, RPDA and RPL.
Drs. Rao, Steg, Jolly, and Mann review the results of the RIVAL trial and discuss how procedural and therapeutic strategies may improve patient outcomes.
Radial approach: A 63-year-old woman with diabetes presented on April 1, 2011 with crescendo angina and shortness of breath (no stress test). Cardiac catheterization revealed 3-vessel CAD (SYNTAX Score 27) and normal LV function. Patient underwent PCI of multiple calcific LAD lesions using ROTA DES. The treatment plan now is for staged FFR/IVUS-guided PCI of RCA (1 lesion) and circumflex (2 lesions).
Radial approach: A 62-year-old man with diabetes presented on March 8, 2011 with unstable rest angina. Cardiac catheterization revealed extensive 3-vessel calcific CAD (SYNTAX score 32) and mild LV dysfunction. Patient underwent PCI of LAD-diagonal using Rota-DES. The treatment plan now is for staged PCI of calcific RCA and circumflex LPL via a radial approach.
Radial Approach: A 68-year-old man with diabetes and extensive peripheral vascular disease underwent cardiac catheterization, which revealed extensive 3-vessel coronary artery disease (SYNTAX score 19) and normal left ventricular function. The patient underwent percutaneous coronary intervention (PCI) of the circumflex artery (proximal and OM1) using the Xience® V DES. The current plan is to perform complex high-risk PCI of calcific right coronary artery (proximal, mid, distal) and calcific left anterior descending artery (LAD)/D2 bifurcation (Medina 0,1,1) lesions via a radial approach.
A 90-year-old woman presented with a non-ST-elevation myocardial infarction on 12/23/2010. Catheterization revealed extensive 3-vessel coronary artery and left main disease (SYNTAX score = 40) with normal systolic left ventricular function. The culprit lesion was a thrombotic in-stent restenosis of mid-right coronary artery bare-metal stent. The patient underwent successful percutaneous coronary intervention (PCI) using high-pressure balloon dilation and cutting balloon PCI. She did well with class II symptoms and now presents for staged PCI of the left system. The current treatment plan is PCI of the left main and left anterior descending arteries/first diagonal bifurcation lesions (Medina 1,1,1). SYNTAX score is 31.
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