A Stent On The Run Dr Khaled Almerri, MD Consultant interventonal cardiologist Chest disease hospital Kuwait
Case • 67 years gentelman • Cardiac risk factors – – – –
DM II Dyslipidemia No HTN Not smoker
• Had NSTEMI Dec 2011 • Dipyridamole myocardial perfusion scan :
– Large area of reversable defect in the inferior and inferoseptal area
• Echo :
– LVEF 50% mild inferior wall HK.
Case • Cath march 2012: – LM: normal – LAD : mild irregularity , no significant stenosis – CX : mild disease – RCA :significant damping with osteal 60% stenosis and long mid 95% – LV: normal
Treatment of the complication • To keep radial artery patent – Low pressure compression – Shorter time of compression – Anticoagulation
• Vascular consultation • Patent both ulnar and radial arteries at 3 months later
Take home message • Incidence 0.5% • Common in – Men – Calcification – With direct stenting – Kinks – RCA Kammler J et.al Am J Cardiol 2006; 98:367–369
Take home message • Can be lost in the coronary artery tree or outside – Intracoronary ( serious) • Retrieve • Deploy • Crush
– Outside into the vascular tree
THANKS