ASSISTANT:
ANESTHESIOLOGIST:
PROCEDURE:
1. Intravascular ultrasound, LAD.
2. Cutting balloon angioplasty of LAD.
3. Angioplasty of diagonals.
4. Stent placement x2 to the LAD.
5. Angio-Seal arterial closure device placement.
PREOPERATIVE DIAGNOSIS:
POSTOPERATIVE DIAGNOSIS:
INDICATIONS FOR PROCEDURE: Patient with decreasing
exercise tolerance. Angiogram performed by Dr. Shenasa
demonstrated proximal and mid LAD lesions and more
calcifications into the LAD.
DESCRIPTION OF PROCEDURE:
Using the 6 French sheath that
was in place, used the EBU 3.5 guide catheter, started the
patient on AngioMax for anticoagulation and used a
Persuader 3 wire to engage the distal LAD and perform
intravascular ultrasound that demonstrated diffuse
calcifications in the LAD. However, in the distal segment
of the mid LAD, there was a circumferential calcification
and narrowing of greater than 80%, and just proximal to
that, in the mid LAD, there was also a 70% circumferential
calcification. The ostium of the second large diagonal
also had about a 70% narrowing, and the ostium of the first
diagonal had about a 50% narrowing.
We proceeded to intervene first to perform the cutting
balloon angioplasty with the 3 mm balloon in the distal
segment and the mid segment of the LAD with moderate
improvement, and subsequently, placed two overlapping
stents. The distal stent was a 2.75 x 16 and the proximal
was a 3.0 x 16. There was plaque shifting in both of the
diagonal that were in this segment, and we used the Pilot
50 wire in the LAD and placed a Persuader 3 wire first in
the distal diagonal and performed an angioplasty with a 2
mm balloon and subsequently, placed in the more proximal
diagonal and did the same with moderate improvement and
good flow down all of the vessels. No sign of dissection.
Angiomax was discontinued, and Angio-Seal arterial device
closure was deployed.
The patient was given 300 of Plavix with an aspirin a day.
He is to take for at least 9 to 12 months.