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Onyx in post-CABG & post-PTCA patient with distal LMCA edge stenosis of stent

post-CABG & post-PTCA

Case presentation

  • 74 Year old Male patient appeared with recent onset of Angina.
  • 1996 – CABG
  • 2003 – LIMA to LAD occluded – AWMI – PTCA to osteal LAD [Penta stent]
  • 2013 – Unstable angina – DE novo lesion of Mid LAD – PTCA [Resolute Endeavor]
  • 2018 – Distal LMCA edge restenosis across the LCX, Patent R. Endevour stent. Osteal LCX 80% stenosis, OM diffuse disease, RCA mid segmet CTO.
  • LIMA to LAD & SVG to OM Occluded. RIMA to RCA patent & post anstomosis PDA signicant stenosis.
  • ADVICE – Redo CABG but refused by patient in view of high risk.

Diagnosis and treatment plan 

  • Echo showed LV RWMA+ of LAD territory, FAIR LV function.
  • Diagnosis: CAD –ACSNSTEMI, HTN+, Dyslipidemia.
  • Procedure: PTCA 2 Stents to LMCA – Minicrush or DK crush
  • Location: LMCA, LAD, LCX.
  • Lesion Severity: Calcified, LAD osteal stent, High risk procedure.
cag: sigificant stenosis of lmca across the lcx with stenosis of osteal lcx.

cag: sigificant stenosis of lmca across the lcx with stenosis of osteal lcx.

lmca to lad crossover stenting using r.onyx stent 3.5* 30 mm across the lcx

lmca to lad crossover stenting using r.onyx stent 3.5* 30 mm across the lcx

final image: successful done ptca lmca

final image: successful done ptca lmca

Resolute onyx: how it made my case easy?

  • Onyx showed excellent outcome in LMCA. There were no signs of residual stenosis or any edge dissection found. The final result was TIMI 3 flow.
  • No occlusion or stenosis of LCx ostium – no plaque shift or carina shift.
  • High risk angioplasty in unstable crashing patient made simple.
  • Easy tracking of stent in calcified, restenosed LM-LAD lesion.

Conclusion

  • The final result was good with TIMI 3 flow & no residual stenosis or dissection
  • Provisional stenting is always a better option in such an unstable patient to bailout his symptoms.
  • IABP should be standby option.

About Author –

Dr. Pankaj Vinod Jariwala, Consultant Interventional Cardiologist, Yashoda Hospitals - Hyderabad
MD, DNB, DNB, MNAMS, FICPS, FACC.
Fellowship in Interventional Cardiology [ICPS, Paris, France]He has performed 5000+ percutaneous trans-luminal coronary Angioplasty & 10,000+ Coronary Angiograms and treated 500+ structural heart diseases (including congenital) with Percutaneous Balloon Mitral Valvuloplasty [PBMV] and other pediatric & adult cardiac interventions.

best Cardiologist in hyderabad

Dr. Pankaj Vinod Jariwala

MBBS, MD, DNB (Cardiology)
Consultant Interventional Cardiologist

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