Case 84: PCI Manual - Double stent thrombosis скачать в хорошем качестве

Case 84: PCI Manual - Double stent thrombosis

A patient who had undergone stenting of a distal left main trifurcation lesion (with stents in the LAD, ramus, and circumflex) presented with thrombosis of the ramus and circumflex stents. Unfractionated heparin, eptifibatide, and prasugrel were given. Wiring of the ramus stent was challenging but was eventually successful using a Caravel microcatheter and a Sion black, polymer-jacketed guidewire. A wire was also placed in the LAD for protection in case of thrombus migration. Attempts to deliver a Penumbra thrombectomy catheter failed, but aspiration was performed with a 6 French Export catheter and balloon angioplasty with a 2.0 mm balloon. IVUS did not show stent underexpansion. After placement of an additional stent TIMI 3 flow was restored in the ramus. Despite multiple rounds of aspiration thrombectomy, balloon angioplasty, vasodilator administration, and stent placement, the circumflex had TIMI 2 flow, but the patient’s symptoms significantly improved. The patient was discharged on life-long dual antiplatelet therapy with aspirin and prasugrel.