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The next live case will be broadcast on Tuesday, May 21 at 8 a.m. ET.
A 69-year-old male presented with CCS class III angina and extensive CAD with prior MIs and PCIs. Cath on 5/14/13 revealed III vessel CAD, CTO in-stent restenosis (ISR) of RCA, and DES diagonal with LVEF 30%. Stress MPI revealed multiple areas of ischemia and infarction in the apical, anterior, inferolateral and inferior segments. Heart Team met but patient declined CABG. Patient underwent Rota DES of circumflex and DES of distal LAD. Patient is now scheduled for complex PCI of CTO DES ISR using rotational atherectomy and intravascular brachytherapy (IVBT).
New for 2013, you can earn CME credit for each archived case!
Live Case Archives With CME
April 2013
April 2013: 53-year old male with NIDDM and positive F/H presented with intermittent chest pain on strenuous exertion and occasional rest associated with SOB for last 3 months.
53-year old male with NIDDM and positive F/H presented with intermittent chest pain on strenuous exertion and occasionally at rest associated with SOB for last 3 months. Cath on 2/26/13 revealed one vessel CAD of total occlusion of mid LAD and LVEF 56%. Patient was inappropriate for PCI because of no documented ischemia and medical therapy; no PCI done. Patient was started on maximal medical therapy and a follow-up stress MPI revealed moderate sized large anterolateral & apical ischemia. Patient is now scheduled for PCI of CTO mid LAD via antegrade or retrograde approach.
March 2013
March 2013: A 73-year-old male with multiple CAD risk factors, CCS Class III angina and high risk MPI presented on 2/8/13.
A 73-year-old male with multiple CAD risk factors, CCS Class III angina and high risk MPI presented on 2/8/13. Cath revealed 3V CAD and LVEF 55% (SYNTAX Score 25). Patient has moderate to severe MR on echo. CABG and MVR was recommended but declined even after Heart Team consultation. Patient underwent PCI of proximal LAD and Ramus Intermedius using an everolimus eluting stent. Now staged for PCI of circumflex/OM1 bifurcation (Medina 1,1,1).
February 2013
February 2013: 60-year-old male with multiple CAD risk factors, CCS Class II angina, presented on 12/21/12 with high risk stress echo for inferior and lateral ischemia.
60‐year‐old male with multiple CAD risk factors, CCS Class II angina, presented on 12/21/12 with high risk stress echocardiogram for inferior and lateral ischemia. Cath revealed 2V CAD (SYNTAX score 20), normal LV function. Patient had successful PCI (DES) of LCx-high lateral. Now scheduled for complex PCI of RCA CTO via antegrade or retrograde approach.
January 2013
January 2013: 68-year-old male with multiple CAD risk factors, CCS Class III angina and low risk MPI presented on 12/28/12.
68-year-old male with multiple CAD risk factors, CCS Class III angina and low risk MPI presented on 12/28/12. Cath revealed 3 vessel and left main disease and hyperkinetic LV function (SYNTAX score 33). Patient had a heart team consultation and CABG was strongly recommended but declined by the patient. The patient is now scheduled for complex high-risk PCI of unprotected left main bifurcation.
Live Case Archives
December 2012
December 2012: 78-Year-Old Female with NIDDM, Dextrocardia & Situs Inversus Presented With NSTEMI; Cath Revealed 2V CAD & Normal LV Function (SYNTAX Score 17)
78-year-old female with NIDDM, dextrocardia & situs inversus presented on 9/7/12 with NSTEMI; cath revealed 2V CAD and normal LV function (SYNTAX score 17). Patient underwent PCI using rotational atherectomy and two everolimus-eluting stents of culprit RCA. Patient continues to do well except for CCS Class II angina. Now scheduled for PCI of calcified LAD/D1 bifurcation lesion in this anatomically challenging patient with dextrocardia.
November 2012
November 2012: 43‐Year-Old Male Presented on 9/22/12 with NSTEMI and Cath Revealed 2V CAD and Normal LV Function (SYNTAX Score 26)
43-year-old male presented on 9/22/12 with NSTEMI and cath revealed 2V CAD and normal LV function (SYNTAX Score 26). Patient underwent culprit vessel PCI of 95% LAD/Diagonal bifurcation lesion using zotarolimus-eluting stent of LAD and CB PTCA of diagonal. Patient continues to have class II angina and a follow-up stress MPI revealed moderate inferolateral ischemia. Patient is now scheduled for PCI of chronic total occlusion (CTO) of RCA using antegrade/retrograde approach.
October 2012
73-Year-Old Male with III Vessel CAD, Status Post CABG x3 (LIMA—LAD, radial—D1 and SVG—OM) Presented on 9/17/2012 with Small NSTEMI
73-year-old male with III vessel CAD, status post CABG x3 (LIMA—LAD, radial—D1 and SVG—OM) presented on 9/17/2012 with small NSTEMI. Patient underwent DES of native LCx-OM1 and DES of radial graft to D1. LVEF 30%. Now planned for PCI of complex tortuous RCA lesions with percutaneous left ventricular assist device.
September 2012
70-Year-Old Male with New Onset CCS Angina Class II and Uncontrolled Hypertension had High-Risk Stress MPI for Multi-Vessel Ischemia
70-year-old male with new onset CCS angina class II and uncontrolled hypertension had high-risk stress MPI for multi-vessel ischemia. Patient underwent cath on September 11, 2012 revealing 3V + LM CAD (SYNTAX score 34) and normal LV function. Patient had heart team consultation and CABG was recommended but strongly refused by the patient. Patient underwent successful PCI of prox and mid RCA using two everolimus-eluting cobalt chromium DES. Patient is now staged for PCI of unprotected LM/LAD/ LCX.
August 2012
65-Year-Old Male with New Onset CCS Class III Angina and Strongly + ETT
65-year-old male with new onset CCS Class III angina and strongly + ETT. Patient underwent cath on August 20, 2012 revealing 3V CAD (Syntax Score 22), and normal LV function. After heart team discussion, patient decided for multi-vessel PCI. Now planned for complex PCI of calcified LAD lesions.
July 2012
65-Year-Old Male Undergoes PCI of LAD with FFR Guidance and Re-try PCI of OM2
A 65-year-old male with multiple CAD risk factors had moderate lateral wall ischemia on stress MPI and presented on May 18, 2012 with new onset CCS Class II angina. Cath revealed extensive 3V CAD and normal LV function: Syntax Score 30. Patient declined CABG after heart-team discussion and subsequently underwent successful PCI of multiple RCA lesions using three platinum-chromium everolimus drug-eluting stents and unsuccessful PCI of CTO LCx-OM2. He still has class I angina on maximal medical therapy. Patient is now staged for FFR-guided LAD PCI and re-attempt at LCx-OM2 CTO.
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