Case study of a patient with triple vessel coronary artery disease undergoing PTCA with graft stenting

Clinical Presentation Mr. Binod Bihari Bhakat, a 72-year-old male, known case of hypertension, diabetes mellitus, chronic kidney disease, ischemic heart disease, S/P CABG (2009), normal LV systolic function was admitted with complaint of typical angina. He was advised for coronary angiography. Coronary Angiography Report Risk Factors Hypertension Type 2 diabetes mellitus ECG Sinus Rhythm T wave inversion V1 – V4 Good LV systolic function AO/LVEDP/PCWP: 160/80/107 Approach – Right femoral Catheters 5F JL JR 3.5 Contrast Media Contrast – Omnipaque Quantity – 50 ml Flurotime: 7.29 Min Left Main: Distal LMCA has 80 % stenosis Ostial LAD has 90% stenosis. Mid LAD has total occlusion Ramus Intermedius: NA LCX/ OM: Dominant Ostial LCX has 90% stenosis Non dominant. Diffusely diseased LIMA/RIMA LIMA-LAD-> Absent SVG-LCX-> Patent SVG-LAD-> Discrete 90% stenosis in proximal half. Distally slow flow noted. LV Angiogram – NA Renal/Angio/Carotid-Angio – NA Any other – NA Final Diagnosis – Native triple vessel coronary artery disease. LIMA-LAD graft absent, SVG-LCX patent graft and significant disease in SVG-LAD graft. Recommendation – PTCA with stenting to SVG-LAD graft Procedure done – PTCA was done through right femoral approach and good flow was achieved in SVG-LAD graft. Procedural Details : PTCA was done through right femoral approach. 6F AR 1.0 guide catheter was used to engage the SVG to LAD graft. Asahi Sion Blue guide wire was taken to cross the lesion. Sequential pre dilatation was done with Ryurei 1.5 x 10 balloon at 12 atm and Ryurei 2.5 x 10 balloon at 14 atm, Yukon Choice PC 3.0 x 24 mm stent was deployed with the support of 6F Guidezilla supportive catheter at 12 atm. Stent boost guided sequential post dilatation was done with balloon Apollo 3.5 x 10 at 20 atm and Apollo 4.0 x 8 balloon at 22 atm. Post…

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