Infero-lateral STEMI with CS due previous malpositioned LAD stent
Consult this Twitter case concerning a patient presented at ER with infero-lateral STEMI and CS.
Patient presented at ER with infero-lateral STEMI and CS. Previous Hx of PCI to ostial LAD 8 months ago.
This case was originally published on Twitter by @evandrofilhobr via #CardioTwitterCase
Clinical presentation
56M, HtN, high lipids, previous hx of LAD PCI 8 months ago in another hospital. 1hr onset of CP, sudoresis, ER with STEMI (infero-lateral) and CS with norepinephrine and dobutamine. It took me 2 hours to fix this.
Case Management
After balloning the origin of LCx/OM the patient was stable and I could #imagefirst and plan what to do. IVUS showed that the LAD stent had struts protuding LM and was probably the cause of this early stent failure involving almost a trifurcation of main vessels
I decided to do a "LATE - nano/minicrush" with previous LAD stent. The LAD stent was undersized/underexpanded. I had to do balloning with 4.0 with high pressure and implant a stent LM (POT)->Big-OM and another stent overlapping at OM (edge/wire dissection). The LAD pinched after that (IVUS). #radialfirst
Original tweet and Twitter discussion
56M, HtN, lipids, previous hx of LAD PCI 8 months ago in another hospital. 1hr onset of CP, sudoresis, ER with STEMI (infero-lateral) and CS with norepinephrine and dobutamine. Took me 2 hrs to fix this. What would you do? #Radialfirst#imagefirst#stopnailingpic.twitter.com/WDicBtV44Q
— Evandro Martins F. MD (@evandrofilhobr) September 20, 2018
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