Hajek, Petr

Stechovsky, Cyril

Veselka, Josef

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TCTAP C-017 Successful Treatment of Prolonged Out-of-hospital Cardiac Arrest with Automatic Mechanical Chest Compression Device and Intra-arrest Primary Percutaneous Coronary Intervention 

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19th CardioVascular Summit: TCTAP 2014TCTAP C-015
An Occlusive Coronary Hematoma 5 Days After Balloon Angioplasty
Yukiyo Sakata, Kenji Sadamatsu
Saga Prefecture Medical Center Kosekan, Japan
[Clinical Information]
Patient initials or identiﬁer number:
K.S.
Relevant clinical history and physical exam:
A 63 year-old man with worsening angina pectoris was transferred to our hospital
because of severe chest pain unrelieved by nitroglycerin. His coronary risk factors
were hypertension, smoking, and family history.JACC Vol 63/12/Suppl S j April 22–25, 2014 j TCTAP Abstracts/CASRelevant test results prior to catheterization:
His electrocardiogram and echocardiogram were normal, and cardiac enzymes were
not elevated.
Relevant catheterization ﬁndings:
Emergency coronary angiograms revealed severely stenotic lesions in proximal and
mid portions of the right coronary artery.
[Interventional Management]
Procedural step:
A 6Fr JR4 guiding catheter was engaged at the ostium of the right coronary artery and
a ﬂoppy guide wire was inserted. We dilated both the lesions with a 3.0x10mm
scoring balloon (Scoreﬂex), and deployed a 3.5x19mm bare metal stent (Coroﬂex) in
the proximal lesion.
Case Summary:
Relevant clinical history and physical exam
A 63 year-old man with worsening angina pectoris was transferred to our hospital
because of severe chest pain unrelieved by nitroglycerin. His coronary risk factors
were hypertension, smoking, and family history.
Relevant test result prior to catheterization
His electrocardiogram and echocardiogram were normal, and cardiac enzymes were
not elevated.
First catheterization ﬁndings and treatment
Emergency coronary angiograms revealed severely stenotic lesions in proximal andmid
portions of the right coronary artery. A 6Fr JR4 guiding catheter was engaged at the
ostium of the right coronary artery and a ﬂoppy guide wire was inserted.We dilated both
the lesions with a 3.0x10mm scoring balloon (Scoreﬂex), and deployed a 3.5x19mm
bare metal stent (Coroﬂex) in the proximal lesion. Intravascular ultrasound ﬁndings
showed a good result in the proximal lesion and only aminor dissection in themid lesion.
Second catheterization ﬁndings and treatment
He had severe chest pain again 5 days after the treatment, and the electrocardiogram
demonstrated ST-segment elevation in the inferior leads. Emergency coronary angi-
ography revealed a sub-total occlusion in the mid portion of the right coronary artery,
where the minor dissection had located in. Intravascular ultrasound ﬁndings demon-
strated a occlusive hematoma, and then we covered the hematoma with a 3.4x19mm
bare metal stent (Coroﬂex). The ﬁnal angiogram showed a good result.
TCTAP C-016
Hanging Left Main Stent in Aorta in a Case of Acute STEMI with Shock with
Left Main Thrombus
Anurag Sharma
Max Hospitals, Mohali, India
[Clinical Information]
Patient initials or identiﬁer number:
Laxman singh
Relevant clinical history and physical exam:
83 Y
[Interventional Management]
Procedural step:
PCI Details:
Right femoral approach
IABP from left femoral approach
Judkins Left 3.5 guiding catheter
Rinato coronary wire
Thrombuster thrombus aspiration device 6F
3.0 X 28 XIENCE V stent
Overlapped by 2.74 X 26 supraﬂex stent
Instent dilatation with 3.5 X 8 MM balloon at 20 ATM.
Case Summary:
83 years old gentleman, presented to our emergency room with sweating, chest pain
and giddiness while going for the evening walk.
He is non smoker, non hypertensive and non diabetic.
His BP WAS 80 mm Systolic,
Chest examination showed bilateral crepitations and room air saturation was 92%.
ECG showed ST elevation in anterior leads including I, AVL, AVR and ST depression
in II, III and AVF.
2d Echo doppler showed severe LV systolic dysfunction and severe MR.
He was taken up for immediate PCI.
IABP was inserted and pt put on the high ﬂow oxygen and PCI was done to left main
and LAD.
Patient recovered well and then discharged on day 4.
TCTAP C-017
Successful Treatment of Prolonged Out-of-hospital Cardiac Arrest with
Automatic Mechanical Chest Compression Device and Intra-arrest Primary
Percutaneous Coronary Intervention
Cyril Stechovsky, Petr Hajek, Josef Veselka
Motol University Hospital, Czech Republic
[Clinical Information]
Patient initials or identiﬁer number:
P.G., J.S.
[Interventional Management]E/Acute Coronary Syndrome: STEMI, NSTE-ACS S73
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19th CardioVascular Summit: TCTAP 2014Procedural step::
Cardiopulmonary resuscitation, deﬁbrillation, use of mechanical chest compression
device LUCAS2 (Medtronic, Minneapolis, MN, USA), intra-arrest pecrutaneous
coronary intervention facilitated with LUCAS2. Case1: Coronary angiography
revealed proximal occlusion of LAD. The closure of LAD was crossed by guidewire
PT MS (Boston Scientiﬁc, USA). The artery was opened with Sapphire II PTCA
Balloon 3x15mm (OrbusNeich Medical, China.) Finally, CoCr stent Skylor 4/25mm
(Invatec, Italy) was deployed with ﬁnal TIMI 3 ﬂow. Case2: Occlusion of LMCA was
crossed by guidewire PT MS (Boston Scientiﬁc, USA). The artery was opened with
Sapphire II PTCA Balloon 3x15mm (OrbusNeich Medical, China). Another guidewire
PT MS was advanced. Finally, CoCr stent Skylor 4/20mm (Invatec, Italy) was
deployed.S74 JACC Vol 63/12/Suppl S j April 22–25, 2014 jCase Summary:
We present a series of two case reports of patients (48- and 60-year-old man without
previous history of coronary artery disease) with acute ST-elevation myocardial
infarction complicated by out-of-hospital cardiac arrest unresponsive to advanced
cardiopulmonary resuscitation. Both patients were treated with use of an automated
mechanical compression-decompression device LUCAS 2 (Medtronic, Minneapolis,
MN, USA). Coronary angiography showed occluded proximal left anterior descend-
ing artery in the ﬁrst case and total occlusion of the left main coronary artery in the
second case. In both patients a successful intra-arrest primary percutaneous coronary
intervention (PCI) was performed. LUCAS could be discontinued immediately after
the reperfusion. Return of spontaneous circulation (ROSC) was achieved in both cases
after 90 minutes of cardiac arrest. The ﬁrst patient survived to hospital discharge
without any neurological impairment, control coronary angiography showed good
result of PCI. On a 1-year follow-up visit he was in a good condition, echocardio-
graphic examination showed mild spherical remodeling of LV with EF 0.35. The
second patient died of cardiogenic shock 11 hours after onset of symptoms. An
echocardiogram performed after ROSC showed increased echogenity of both right
ventricle and interventricular septum (IVS) and ”hypertrophy“ of right ventricle
(8mm), IVS (14mm) and lateral wall of left ventricle suggesting cardiac contusion. An
autopsy revealed a transmural anterolateral myocardial infarction but also massive
subepicardial hemorrhage, extreme LV ”hypertrophy“ with IVS and lateral wall
thickness of 24mm and 22mm respectively and interstitial edema and hemorrhages on
histologic samples from regions of the myocardium outside the infarction itself and
also from the right ventricle. These lesions were concluded to be a myocardial
contusion.
TCTAP C-018
Simple Transradial Intervention Becomes Complex
Mir Jamal Uddin
National Institute of Cardiovascular Diseases, Bangladesh
[Clinical Information]
Patient initials or identiﬁer number:
AS
Relevant clinical history and physical exam:
A young man of 38 years presented with gradual onset of exertional chest discomfort
NYHA stage jjj. He was known diabetic and hypertensive. On examination o/e pulse
70/min.blood pressure 150/100 mmhg.Heart and lungs revealed no abnormality other
systemic examinations revealed normal
Relevant test results prior to catheterization:
ECG showed inferior ischemia. Echo Revealed regional wall motion abnormality.ETT
was positive.Other biochemical tests remained normal
Relevant catheterization ﬁndings:
transradial CAG done which revealed LM-normal LAD -normal LCX-normal RCA-
mid 70-80% % lesion
[Interventional Management]
Procedural step:
TRI planned radial guide catheter (tiger) 6F was engaged to the RCA ostium. Guide
catheter hits the proximal RCA twice. And there occurred a dissection. A BMW wire
was crossed the lesion. The lession was pre dilated with 1.5  20 mm balloon. There
was another dissection occured in the mid part of RCA.i decided to stand it with a long
DES 2.75x28 mm. After deploying the stand at the mid part of RCA, good TIMI jjj
ﬂow achieved. Then proximal dissection ﬂap was covered by another DES 3.0x28 mm
at 16 atm. After placing the secondstand I noticed there was haziness at the distal end
of ﬁrst stand with distal slow ﬂow.I thought it was another dissection by the stand. So I
deployed another DES at the distal RCA which was 2.75x16 mm over lapping the ﬁrst
stand. Final result was good with TIMI jjj ﬂowTCTAP Abstracts/CASE/Acute Coronary Syndrome: STEMI, NSTE-ACS


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TCTAP C-017 Successful Treatment of Prolonged Out-of-hospital Cardiac Arrest with Automatic Mechanical Chest Compression Device and Intra-arrest Primary Percutaneous Coronary Intervention

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