ljones1216
Contributor
Impressions
Two-vessel coronary artery disease
Severe in-stent restenosis within mid RCA
Positive FFR of RCA
Successful cutting balloon angioplasty to mid RCA with 3.0 x 10 mm Wolverine balloon
Elevated LV filling pressure
Abdominal aortography with runoff showing no severe renal artery stenosis and no significant PAD in the aortoiliac system
Coronary Findings
Diagnostic
Dominance: Right
Left Main
The left main was selectively engaged with a catheter and visualized by angiography. Other findings: Large caliber vessel that is angiographically normal..
Left Anterior Descending
The LAD was visualized by angiography. Other findings: Medium to large caliber vessel proximally with a ledge-like 30-40% proximal stenosis. The mid to distal vessel has diffuse luminal irregularities but no area of critical stenosis. The first diagonal is a sizable branching vessel that has mild luminal irregularities but no critical stenosis..
Left Circumflex
The circumflex was visualized by angiography. Other findings: Medium to large caliber vessel with a 20-30% proximal stenosis. The mid stent is patent with 20-30% in-stent restenosis. OM1 is angiographically normal..
Right Coronary Artery
The RCA was selectively engaged with a catheter and was visualized by angiography. Other findings: Medium to large caliber dominant vessel with a proximal 20-30% stenosis. There is a patent stent in the mid vessel (2 layers) with 60-70% in-stent restenosis proximally and 50-60% in-stent restenosis distally. The RPDA is small with mild ostial disease. The RPL has a patent proximal stent with 30-40% in-stent restenosis that appears stable from prior angiograms. There are 2 branches to the RPL that have mild luminal irregularities..
Mid RCA lesion is 70% stenosed. This is the culprit lesion. The lesion is not complex (non high-C). The lesion was previously treated using a drug-eluting stent. Previous treatment took place 1-2 years ago. There is in-stent restenosis. There is no in-stent thrombosis. The stenosis was measured using by visual assessment.
Intervention
Mid RCA lesion
POBA
Guide catheter used: CATH GUIDE 6F FR4 BOSTON SCI.Guidewire that crossed the lesion: GUIDEWIRE PROWATER .014"X180CM STRAIGHT PTCA ASAHI INTECC. Angioplasty using a scoring balloon was performed. The balloon used was a CATHETER BALLOON CUTTING 3.00X10MM WOLVERINE BOSTON. Maximum pressure: 12 atm. Comments: Inflated both proximally once and distally once within previously placed stent.
Post-Intervention Lesion Assessment
There is no residual stenosis post intervention.
Left Heart
Left Ventricle LV end diastolic pressure is moderately elevated and was measured at 30 mmHg. Comments: Abdominal aortography with runoff: Abdominal aorta is patent. Left renal artery has a 30% proximal stenosis. Right renal artery is patent with no significant stenosis. Bilateral common iliac, bilateral internal iliac, and bilateral external iliac arteries are patent with no significant stenosis. Bilateral common femorals are patent with no significant stenosis..
Two-vessel coronary artery disease
Severe in-stent restenosis within mid RCA
Positive FFR of RCA
Successful cutting balloon angioplasty to mid RCA with 3.0 x 10 mm Wolverine balloon
Elevated LV filling pressure
Abdominal aortography with runoff showing no severe renal artery stenosis and no significant PAD in the aortoiliac system
Coronary Findings
Diagnostic
Dominance: Right
Left Main
The left main was selectively engaged with a catheter and visualized by angiography. Other findings: Large caliber vessel that is angiographically normal..
Left Anterior Descending
The LAD was visualized by angiography. Other findings: Medium to large caliber vessel proximally with a ledge-like 30-40% proximal stenosis. The mid to distal vessel has diffuse luminal irregularities but no area of critical stenosis. The first diagonal is a sizable branching vessel that has mild luminal irregularities but no critical stenosis..
Left Circumflex
The circumflex was visualized by angiography. Other findings: Medium to large caliber vessel with a 20-30% proximal stenosis. The mid stent is patent with 20-30% in-stent restenosis. OM1 is angiographically normal..
Right Coronary Artery
The RCA was selectively engaged with a catheter and was visualized by angiography. Other findings: Medium to large caliber dominant vessel with a proximal 20-30% stenosis. There is a patent stent in the mid vessel (2 layers) with 60-70% in-stent restenosis proximally and 50-60% in-stent restenosis distally. The RPDA is small with mild ostial disease. The RPL has a patent proximal stent with 30-40% in-stent restenosis that appears stable from prior angiograms. There are 2 branches to the RPL that have mild luminal irregularities..
Mid RCA lesion is 70% stenosed. This is the culprit lesion. The lesion is not complex (non high-C). The lesion was previously treated using a drug-eluting stent. Previous treatment took place 1-2 years ago. There is in-stent restenosis. There is no in-stent thrombosis. The stenosis was measured using by visual assessment.
Intervention
Mid RCA lesion
POBA
Guide catheter used: CATH GUIDE 6F FR4 BOSTON SCI.Guidewire that crossed the lesion: GUIDEWIRE PROWATER .014"X180CM STRAIGHT PTCA ASAHI INTECC. Angioplasty using a scoring balloon was performed. The balloon used was a CATHETER BALLOON CUTTING 3.00X10MM WOLVERINE BOSTON. Maximum pressure: 12 atm. Comments: Inflated both proximally once and distally once within previously placed stent.
Post-Intervention Lesion Assessment
There is no residual stenosis post intervention.
Left Heart
Left Ventricle LV end diastolic pressure is moderately elevated and was measured at 30 mmHg. Comments: Abdominal aortography with runoff: Abdominal aorta is patent. Left renal artery has a 30% proximal stenosis. Right renal artery is patent with no significant stenosis. Bilateral common iliac, bilateral internal iliac, and bilateral external iliac arteries are patent with no significant stenosis. Bilateral common femorals are patent with no significant stenosis..