Dr Hore D . R MD (Medicine) DNB (Cardiology)MD (Medicine) , DNB (Cardiology)

Interventional cardiologistW kh d H i l NWockhardt Hospital , Nagpur

India

Mr. B. H . 62 Yrs Male Symptoms : Chest pain since 8 hours Risk factors : HTN DM Risk factors : HTN ,DM Diagnosis : Acute anterior wall STEMI , g ,

Acute LVF (Killp class II)

ECG : i llAcute Anterior Wall

STEMI

2 D ECHO :LAD Territory Akinetic LVEF – 30 % Mild MR

Primary PCI to IRA

IABP Support - If needed pp

ACS – AWSTEMI S LV S t li D f ti Severe LV Systolic Dysfunction

Left Dominant Systemy

Diff F th PAMI C Differs From other PAMI Cases ACS – High Risk Subset gWire Negotiating point – Ostial LAD no stump L k A Ch i T l O l i Looks Acute on Chronic Total Occlusion

RFA Guide EBU 7 Fr Guide – EBU 7 Fr

1.25 X6 MM SPRINTER @ 14 ATM

2 X 12 MM SPRINTER BALLOON AT 12 ATM 12 ATM

• Primary PCI of flush total occlusion of Ostial LAD with dominant LCX is challenging LAD with dominant LCX is challenging

• In this case we observed acute on chronic total occlusion of culprit vessel - A novel total occlusion of culprit vessel A novel findingLi it ti i bl i li ti• Limitation is unable visualize ostium

• IVUS is useful in such cases to navigate wireg• Hooking of ostium is initial step of wire

manipulation manipulation

Prolong manipulations in patients with ti l l d i t LCX l d t particularly dominant LCX can lead to

catastrophic complications like LMCA p pdissection , thrombus formation