The curious case of a crooked artery
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A 66-year-old male patient presented to hospital with complaint of chest pain 1 hour prior to admission. A diagnosis of acute inferior wall myocardial infarction was made and he was thrombolysed with Tenecteplase.
His coronary angiography was done which showed very tortuous RCA vessel with a tight lesion (about 90%) in mid RCA (Right coronary artery) with post stenotic aneurysm. PTCA to RCA was planned. During the procedure, as soon as the 0.014 inch BMW (balance Middleweight Wire) was advanced, it could not cross the tortuous proximal part of the vessel. An 0.014 inch All star wire was taken and advanced into the distal end of the vessel with the support of 2mm*12mm Mini Trek balloon. As soon as the wire crossed the lesion, the proximal part of patient’s artery showed increased narrowing.
The ECG on the monitor at this point of time showed ST elevation and rate dropped to 40beats/minute. The balloon was quickly inflated at the site of lesion. The vessel thereafter had slow flow distally. IV nitroglycerin was repeated and 2.5mm*23mm Everolimus stent was deployed at the site of lesion. Post procedure, the vessel had TIMI 3 flow with BP of 90/60mm. ECG showed settling of ST elevation in inferior leads. Patient had relief in the chest pain and was shifted out of cath lab.
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The curious case of a crooked artery
Author
Bali R.1
- Hero DMC Heart Institute, Ludhiana, Punjab, INDIA
2 comments
This concertina effect is commonly observed during percutaneous intervention of a right coronary artery with a shepherd's crook shape or highly tortuous coronary arteries. I believe that when this occurs, the operator should review the initial reference images to avoid treating healthy segments of the artery.
Very nice depiction of the concertina effect. RCA looks more than 2.5 mm though