2009 CIT CASE REVIEW

Li Weijie Department of Cardiovascular Medicine, Xijing Hospital

Case 1 History (2009-3-21)

Male, 55 years old

Complain: Paroxysmal chest distress with palpitation for 3 years Aggravated for 3 months

Past history: HypertensionStents (Cypher) implantation at RCA 2-3 and 4PD (2008-12)

Diagnosis

1. Coronary artery disease

Unstable angina pectoris

Old inferior myocardial infarction

NYHA class I

2. Stage 2 hypertension

ECG

Old inferior myocardial infarction

Ultrasound

Ejection Fraction 60%

Coronary angiography

RCA2 25%; 4AV ostial 90%; RCA2-3, 4PD Free of in-stent restenosis

LAD6 99%; LAD7 100%; LCX12 80%; LCX13 25%; LCX15 50%

Coronary angiography

LAD6 99%;

LAD7 100%;

LCX12 80%;

LCX13 25%; LCX15 50%

Coronary angiography

Collateral Circulation

Retrograde wire

Runthrough FielderMicro-catheter

M3

Forward wire

Fielder

Confirm the true luminal

Stents implantation

2.75mm×33mm FIREBIRD 3.0mm×23mm FIREBIRD

Coronary angiography

Follow up (2010-3-18)

Complain: Mild chest distress

UCGEF 55%

ECGOld inferior myocardial infarction

Coronary angiography

LAD6-8 Free of in-stent restenosis; LAD8 25%; LAD9 90%; LAD10 95%; LCX12 100%; LCX14 95%; LCX15 50%

Coronary angiography

RCA1 25%; RCA2 25%; 4AV ostial 90%;RCA2-3, 4PD Free of in-stent restenosis

Balloon dilation

2.5mm×20mm

Stent implantation

LCX13-14 2.75mm×29mm FIREBIRD2 14ATM 15s

Finall results

Intramural hematoma

Case 2 History (2009-3-21)

Male, 55 years old

Complain: Paroxysmal chest distress with

short of breath for 2 months

Diagnosis: Coronary artery disease

Unstable angina pectoris

ECG

Sinus rate 76 bpm, normal ECG

Coronary angiography

LMT 5 30%;LAD 6 ostial 90%; LAD 9 75%

LCX OM3 50%; LCX 15 75%

Coronary angiography

RCA 2 30%; RCA 3 50%; 4PD ostial 75%

Guiding 7F EBU 3.5

BMW Rinato Runthrough 2.5mm×29mm Firebird

Stent implantation

LCX13-15-OM3 2.5mm×29mm Firebird 16ATM 7s 18ATM 7s

2.5mm×13mm Firebird 2.0mm×20mm balloon

3.5mm×23mm Firebird 2.0mm×20mm balloon

3.5mm×20mm 10ATM 2.5mm×20mm 10ATM

Follow up

• Suesequent visit: the patient feel well, no complaint,no symptom

• Unwilling to subsequent CAG