Acute ThrombosisAcute Thrombosis in LIMA Intervention

Doni FirmanHarapan Kita National Cardiovascular Center /

Department of Cardiology and Vascular Medicine Faculty of Medicine University of Indonesiay y

History• 68 yo lady• Stable angina CCS III• Stable angina CCS III• CRF : Hypertension ,DM II• EKG : NSR• EKG : NSR• Echo : apicoseptal hypokinetic, EF 56%• CABG 1998 :CABG 1998 :

SVG to PDASVG to PLSVG to OM2LIMA to LAD

THERAPY

• ISDN 10 MG td• Lisinopril 10 mg od• Adalat oros 30 mg odg• Aspirin 80 mg• Plavix 75 mg od• Plavix 75 mg od• Simvastatin 20 mg • Lantus 14 Unit• Gludepatic 500 mg odp g

Diagnostic

SVG to PDA

SVG to PLSVG to PL

Left System

SVG to OM2

LIMA to LAD

PCI SVG-PDA

Yangtze balloon 3.5 x 20 mm, Hiryu NC 3.5 x 15 mm, Chrono 3.5 x 12 mm 18 atm

LAD Intervention via LIMA

JR 3.5 6F, HT Floppy wire, support with Voyager 2.0 x 15 mm

LAD Intervention via LIMA

THROMBUSTER II 6F . Eptifibatide IV bolus

AFTER NITRATE TOTAL 500 MCG I.C.

• Stop procedureStop procedure• CCU• Eptifibatide IV 2 days• UFHUFH• Asprin 320 mg od• Plavix 75 mg bd• Chest pain reduced• Chest pain reduced• No ECG changes• No elevation cardiac enzyme

3 Days Later

JR 3.5 6F

JR 3.5 6F, runthrough floppy wire, progreat 2.0

Voyager 1.5 x 12 mm 6 atm

Chest Pain

• NTG I C 300 mcg• NTG I.C 300 mcg• Verapamil IC 2.5 mg• Adenosine IC 40 mcg• Chest pain : reduced• Chest pain : reduced• Angio : not change

Sprinter 2.0 x 15 mm 15 atm

Final Result

Take Home Massage

• LIMA is not a ‘benign’ vessel compare with SVG

• Be gentle with your wireBe gentle with your wire