Consultant Interventional Cardiologist(Ahalia Diabetes Hospital), MD(Medicine), DM (Interventional Cardiology)
A 69/F came with chest pain of 2 hours, her ECG had no ST elevation, but ST depression in anteroseptal leads with terminal upright T waves. We did a posterior LEADS ECG which showed frank elevation. The patient was posted for Primary CAG- Which showed Proximal LCX-TOTAL Cut Off. After pre dilatation there were two discrete lesions. Distal Ballooning led to dissection. The wire recrossing across the dissected segment had to be appropriately managed. The proximal LCX-OM stent was also difficult to cross. Lessons from the procedure - 1) If we have a wire loss across the dissected segment, rewiring should be done with rapid wiggling to avoid going inside the dissection flap. 2) If stent recrossable lesions, of all the techniques available, use of a Guide extension Cather is a helpful tool to push the stent across the tortuous vessel. 3) Two hand technique- One hand in the guide and another in the catheter helps push the stent. 4) Asking the patient to take a deep breath helps sometimes to streamline the vessel and increases the pushability.
