A case of no-reflow phenomenon during PCI to LIMA graftsummitmd.com/pdf/pdf/1378_LITA-noreflow_English.pdf · no-reflow phenomenon. Iwatsuki Minami Hospital PCI Nitroprusside 60 microgram

Iwatsuki Minami Hospital

A case of no-reflow phenomenon during PCI to LIMA graft

Iwatsuki-Minami hospital, Saitama, Japan

Koichi Sano, Masaki Tsukagoshi, Yasunari Ueno, Seiichi Fukuda, Takayoshi Sato, Yasuyuki, y , yMaruyama


Medical history77 y.o. male

This patient was hospitalized by inferior AMI 12 yearsThis patient was hospitalized by inferior AMI 12 years

ago, and was performed CABG x3 (LIMA-LAD, SVG-

RCA, SVG-OM) because of his LM+multivessel disease.

He was referred to our hospital for the routine check-upHe was referred to our hospital for the routine check up.

Treadmill exercise test showed positive for ischemia

(Bruce 4min). Therefore, CAG was performed.CAG had been performed 1.5y ago in another hospital, and LIMA-

LAD didn’ have a significant stenosis.


Risk factor□ Hypertension BP110/60, ARB, β-blocker

□ Hyperlipidemia LDL121mg/dl tocopherol nicotinate(+)

✔

✔□ Hyperlipidemia LDL121mg/dl, tocopherol nicotinate(+)

□ Diabetes HbA1c 5.8%, voglibose(+)

□ F k✔

✔

✔□ Former smoker 1pack x 40years

□ Family history father; heart disease(?)✔

✔

E h di h

□ Others Cr1.5mg/dl, UA7.1mg/dl✔

EchocardiographyInferior wall: akinesis, LVDd/Ds 53/41, EF 45%e o a a es s, d/ s 53/ , 5%Moderate MR


CAGCAG

RCA;RCA; Total occlusion


CAGCAG

LCA;LCA; Total occlusion


CAGCAG

SVG OM;SVG-OM; Patent


CAGCAG

SVG RCA;SVG-RCA; Patent


CAGCAG

LIMA LAD;LIMA-LAD; 75% stenosis x2


CAGCAG



CAGCAG



CAG -summary-CAG -summary-CAG summaryCAG summary

12 years after CABG (LIMA-LAD, SVG-RCA, SVG-OM)y ( )

He was referred to our hospital for the routine check-up, not

b f ACSbecause of ACS.

Both of native right and left coronary arteries were occluded.

Both of 2 SVGs were patent, but LIMA-LAD had 2 stenoses.

Stenoses of LIMA were located at its body not at theStenoses of LIMA were located at its body, not at the

anastomosis.

PCI was performed 3 weeks after the CAG.


PCIPCI

LIMA-LAD; 75% stenosis x2

*PCI was performed ith 6F idi iwith 6Fr guiding via

his left radial artery.


PCI-LIMAPCI-LIMA

Pre PCI IVUS;distal lesion

Lesion length: 19mmLesion length: 19mm


PCI-LIMAPCI-LIMA

Pre PCI IVUS;prox lesion

Lesion length: 13mmLesion length: 13mm

Iwatsuki Minami HospitalAttenuated plaque at LITA

PCIPCI Attenuated plaque was A

p qseen in prox and distal lesions.

BA

B

B

CB

C

C

C


PCIPCI

POBA was performed without any distal protection deviceprotection device.The balloon was Sprinter 2.5x15mm.


PCIH21.10.28

PCIH21.10.28H21.10.28H21.10.28

ST elevation in V3-6 with chest pain waswith chest pain was seen after balloon dilation.

Angiogram showed no-reflow phenomenonphenomenon.


PCIPCINitroprusside 60 microgram was given super-selectively from very distal of LIMA graft d sta o g a tvia CrusadeTM (a multifunctional probing catheter)probing catheter).

ST level cameST level came back to the normal level, and hi h t ihis chest pain disappeared.








PCIPCI

Taxus Liberte2 5 242.5x24mmMax14atm


PCIPCI

Taxus Liberte2 75 162.75x16mmMax14atm


PCIPCI

Final angiog

Next day;

CK188IU/l

No ECG change was

seen.


Summary

We have experienced a case of LIMA graft stenosisWe have experienced a case of LIMA graft stenosis

with attenuated plaque by IVUS, and no-reflow

phenomenon occurred during the PCI.

This case has shown the usefulness of IVUS guidedThis case has shown the usefulness of IVUS guided

PCI. We should be careful when we perform PCIs to the

lesions with attenuated plaque, and a distal protection

device must be considered.

Documents

A case of no-reflow phenomenon during PCI to LIMA graftsummitmd.com/pdf/pdf/1378_LITA-noreflow_English.pdf · no-reflow phenomenon. Iwatsuki Minami Hospital PCI Nitroprusside 60 microgram