Case Title
Optimal measures for LIMA Interventions.
Case History
A This 47 year old male patient had previous bypass surgery 4yrs ago and he had recent onset of class-2b angina.He had received lima to LAD and radial grafts to OM1 and OM2. Culprit lesion was severe narrowing at the anastomatic site of the IMA and LAD . There was 80% focal lesion at the anastomatic point.
Investigation Reports
While LIMA interventions are planned following things are worth keeping in mind:
- LIMA proximal is usually catheterised well by LIMA catheter introduced from femoral artery, but a times one may need to go and use radial or left brachial approach.
- Short guide catheter should be made available. At times the length required to reach upto the anastomatic site both for wire and balloon catheter may fall short.
- A good backup support is mandatory because very often LIMA graft is very tortorous.
- Choose hydrophilic wire with extra support such as choice PT extrasupport wire (TM Boston Scientific) because hydrophilic wire glides through the curve smoothly and extra support property of the wire helps to straighten up the curve. LIMA is very often prone to spasm. It is our usual practise to keep nitroglycerine and papavarine on the table. Balloon should be easily trackable to traverse through the tortousity.
Click on the thumbnail images to see the videos |
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This shows adequate engagement of left imternal mammary artery with LIMA guide catheter-6f.
Note: The guide catheter is not truly alinged and making further attempt to align it may result into trauma of proximal end or spasm of LIMA. |
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Choice PT extra support wire was quite easily negotiated through all curves of LIMA graft and was parked distally into native LAD. |
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2.5 x 15 mm maverick balloon was used to predialate the lesion. |
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Partial inflated balloon showing the waist of the lesion. |
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Post balloon dialation angiographic view shows severe spasm particularly into the distal LAD. |
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This patient has responded very well to the intra LIMA nitroglycerine. |
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Shows stent deployment of 2.5 x 20mm taxus stent. |
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Shows good result of stent deployment. Distal LAD now fills up very well |
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Courtesy
Dr. A.B. Mehta
Director Of Cardiology,
Jaslok Hospital,
Mumbai, India.
Website: http://www.drabmehta.com
Email: drabmehta@cardiovalens.com
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