In this case review, Dr. Jose de la Torre Hernández from University Hospital in Santander, Spain, explains his approach in treating a complex patient with a combination of physiology, imaging and Co-registration. The use of these tools allow him to better understand the serial lesions in the LAD and Circumflex as well as disease morphology and the optimal stent placement in these vessels.
Hello. My name is Jose Maria de la torre Hernandez. I am the head of interventional cardiology department Here in the hospital Universitario Marquez Valdes via in Santander in the north of Spain the case corresponded to an 80 years old patient. A male with diabetes have the pressure smoker, previous history of coronary artery disease and inferior steamy In 1999 a lot of years back and he was sitting at that time with funeral license. The patient did well. And just recently a couple of weeks ago he was admitted he complained of chest pain, address for 20 minutes, feeling of discomfort for Disney and chest pain with exercise in the previous weeks. Uh an E. K. G. With science rhythm. Q. Wave in inferior leads ST depression in lateral entrepreneur was mildly elevated and in the echo back in asia and inferior segments and ejection fraction was somehow preserved. The angiography showed that there was a three vessel disease chronically occluded, R. C. A. And in the left A proximal cirque with 60% 70% stenosis. Distal cirque With a type 90% stenosis. And in the l. e. d. The vessel was diffused disease with classification. Strong classification with industrial classifying nodule and a severe stenosis. And in the mid portion led Election that could be also a suspicious 70 75%. The decision in the initially in the heart in was to think about the possibility of cabbage through the patient and the family was more in favor of P. C. I. And also of my abilities to be demonstrated that inferior segments were not viable. So we have the two branches in the left corner actually with problems and we decided to do to this procedure today. As I've seen the vessels by pressure wire and we could uh very nicely demonstrate that in the cirque only the dissolution was significant. And we fixed this lesion and the proximal lesion was not significant either before and after the treatment of the diesel left this lesion alone. Moving to the led the pressure wire at the beginning and tell us that the population is approximately meet mid to distal were significant. And we started with the proximal because the ship was involved. It was hard because very classified mission but finally we couldn't stand the lesion with I wish we could really check the expansion was reasonable. Good. Not excellent because we have some point spot with more classification recipe facilitation. We evaluated the result with a goose spanish. It was reasonable. Good. And we reassess the lady this sally and the other leadership was significant. We knew from the beginning but and we treated this lesion that was easier because it was not really very calcified. Okay. We were very happy because at the end we interrogated again the vessel and we get this 0.9 final result in the led taking into account that is a very diffuse disease. Then we have the three stents implanted digital cirque approximately di and Mick Mick Diesel LED and all the procedure was guided by the pressure wide assessment by I. F. R. Administration was very important to really see where the different I stayed up miss of the or drop of the pressure was located and to guide the procedure and imaging was important also to um to guide the stenting in the particularly lady. Then I think the case is very illustrative. It's very helpful to learn how to work with dan demolitions and what you can expect with different combinations of severity between boston delusions. I think I hope that the case would be good for you and you could really take some lessons from it. Thank you.
