A patient presented with NSTEMI and was found to have a severe mid LAD culprit lesion. After balloon angioplasty, dissection was seen in the proximal LAD, likely due to guide-induced dissection (Challenge 1). After wiring the circumflex and a diagonal branch originating within the area of dissection the proximal LAD was successfully stented pinching the ostium of the diagonal (Challenge 2). After rewiring the diagonal and kissing balloon angioplasty the diagonal lesion resolved, but a filling defect appeared on the proximal cicrcumflex (? plaque protrusion vs thrombus - Challenge 3a). After IVUS a stent was placed from the left main into the circumflex with a nice result, but a new filling defect appeared within the LAD (acute stent thrombosis, Challenge 3b). Cangrelor was administered, followed by Penumbra thrombectomy and balloon angioplasty of the LAD with a nice final result.
Негізгі бет Case 154: Trifecta
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