No problem. I'm really thrown off on the SVG. Thanks for responding.
PROCEDURE
1. Left heart catheterization.
2. Saphenous vein graft injection.
3. Percutaneous coronary intervention with drug-eluting stent to
distal circumflex.
INDICATION Unstable angina, borderline troponin.
PROCEDURE IN DETAIL Risks, benefits, alternatives, goals, possible
complications, need for team approach were discussed with the
patient. Informed consent was obtained. A 5-French sheath was
inserted into right femoral artery under sterile technique. We used
JL4 Williams right, RCB pigtail to do left heart cath. This showed
LVEDP 13. No gradient across the aortic valve. Ejection fraction
50% with inferior wall hypokinesis. Right coronary artery was
dominant, was 100% occluded proximally. There was a patent saphenous
vein graft to right PDA that filled antegradely and retrogradely.
The left main had diffuse 30%, LAD had diffuse 30% disease. The
proximal circumflex had multiple 20% to 30% lesion. Distal
circumflex had an 80% focal lesion. In view of the current
presentation and recurrent hospitalization with the patient, decided
to go ahead and treat that. Upsized to 6-French sheath, used XB 3.5
to engage left main, provided good fit and support with a BMW wire
crossed distally. I advanced a 2.25 x 8 Xience, deployed that at 12
atmospheres, reduced the lesion in the distal circumflex from 80% to
0% and TIMI-3 flow was maintained. At the end of procedure, the
patient was hemodynamically stable and comfortable. No complications.