Sponsored by:

Complex Coronary Cases Live

Presented by ACC and the Mt. Sinai Medical Center


Jump to: Live Case Archives | Live Case Archives-CMEFaculty | Program Information

Join Drs. Sharma, Kini and Mehta as they present advanced interventional techniques used in complex cases LIVE from Mount Sinai's catheterization lab. Live cases are broadcast on the third Tuesday of each month.
Comments Icon Comments



2014 Live Case Archives

March 2014

A 76-year-old woman presented on March 3, 2014 with new onset CCS Class III angina, exertional dyspnea and positive ETT. A cardiac cath revealed native 3 vessel coronary artery disease (RCA, LAD, LCx; SYNTAX score of 17) and normal LV function. Patient had successful intervention of mid LAD and distal LCx using everolimus-eluting platinum chromium stents. Now planned for PCI of chronic total occlusion of anomalous RCA originating from left coronary sinus.

February 2014

February 2014: A 82-year-old male with exertional dyspnea and negative stress MPI underwent coronary CTA revealing extensive calcific three vessel coronary artery disease. A cardiac cath on January 10, 2014 revealed calcific three vessel CAD with high SYNTAX score of 36. Heart Team consultation recommended CABG but was declined by the patient due to prior small CVA. Patient continued to be symptomatic despite optimal medical therapy. Now planned for high-risk PCI of multiple calcific lesions of RCA as the first part of multivessel staged PCI.

January 2014

January 2014: A 52-year-old male with NIDDM presented on January 13, 2014 with new onset unstable angina and inferolateral T wave changes. A cardiac cath revealed complex 2 vessel coronary artery disease with multiple lesions of right coronary artery & left circumflex and normal LV function; SYNTAX score 23. Patient underwent DES x3 of RCA and did well. Now planned for complex PCI of calcified bifurcation, complex lesions of left circumflex coronary artery.

2013 Live Case Archives

December 2013

December 2013: A 69-year-old male presented on November 4, 2013 with unstable angina. Cardiac cath revealed 3V + LM CAD (95% calcified ulcerated proximal-mid RCA, 80% calcified proximal LAD, 60% mid LAD, 70% proximal LCx and 60% distal LM) with LVEF 50% and SYNTAX score 45. CABG was recommended but declined after Heart Team discussion. Patient underwent orbital atherectomy and DES x2 of proximal and mid RCA and did well. Patient still has CCS Class II angina and now planned for FFR & OCT guided intervention of LAD, LCx and LM using atherectomy and DES.

November 2013

November 2013: A 73-year-old male presented on Oct 21, 2013 with new onset Class II angina and large inferolateral and mild lateral wall ischemia. Cardiac Cath revealed 3V CAD (90% moderate size D1, 100% small OM2 and 100% large proximal RCA, fills via LAD and LCx collaterals) and LVEF 60%; SYNTAX score 21. Patient underwent DES of D1 with excellent results. Patient continued to have Class II angina on maximal medical therapy. Now planned for PCI of CTO RCA via antegrade and/or retrograde approach.

October 2013

October 2013: A 79-year-old female with multiple CAD risk factors, prior MI and CVA presented on Sept 10, 2013 with Non-STEMI and CHF. Cardiac cath revealed calcific severe 3V CAD and LVEF 22%, with a SYNTAX score 23. Cardiac MRI revealed viability in all segments. CT surgery consultation obtained, but CABG was declined. Patient is now scheduled for complex PCI of RCA and LAD using rotational atherectomy and DES with a left ventricular assist device.

September 2013

September 2013: A 56-year-old male with multiple CAD risk factors and new onset exertional fatigue underwent stress echo revealing fall in LVEF (50% from baseline of 59%) with multi segment hypocontractility. 
A cardiac cath on July 11, 2013 revealed two vessel CAD (CTO of prox RCA and CTO of mid LAD) and minimal LV dysfunction. Patient underwent PCI of prox RCA CTO with everolimus drug-eluting stent and did well. Patient continued to have symptoms of exertional fatigue. The patient is now scheduled for staged PCI of mid LAD CTO using antegrade approach.

August 2013

August 2013: 62-year-old male with NIDDM, new onset of angina, and positive stress echo for infero-lateral ischemia presented on June 26, 2013, which revealed 3V CAD (60% proximal LAD, 80% distal LCx, 100% distal RCA) and normal LV function (SYNTAX score 22). Patient was recommended CABG but declined and underwent zotarolimus-eluting stent (3.5/30mm) PCI of distal LCx. Patient continues to have class II angina on MMT and is now scheduled for PCI of CTO RCA using retrograde recanalization approach.

July 2013

July 2013: 64-year-old male with long standing CAD and multiple prior PCIs, presented on July 14, 2013 with progressive crescendo angina.
Cardiac cath revealed 3V + LM disease (SYNTAX score 32) with mild LV dysfunction. Cardiac surgical consultation was done and CABG declined (due to poor distal targets). Patient underwent PCI using RotA + PTCA of distal RCA DES ISR and is now scheduled for complex PCI of LM bifurcation and distal LAD.

June 2013

June 2013: 62-year-old male presented with class I angina and positive stress echo.
Cardiac cath on June 4, 2013 revealed 2V + LM CAD, occluded LIMA to LAD and occluded SVG to OM and LVEF 55%. Patient had prior paclitaxel DES PCI of proximal LAD and now presents with 99% ISR. Patient was recommended to re-do CABG but declined. Patient is scheduled for complex PCI of unprotected distal LM, LAD and proximal LCX after OCT and near infrared spectroscopy with IVUS imaging.

2013 Live Case Archives With CME

May 2013

May 2013: 63-year-old male with prior CABG and multiple PCIs of LM and LCX presented with crescendo angina and + MPI in inferolateral segment.
63-year-old male with prior CABG and multiple PCIs of LM and LCX presented on 2/7/13 with crescendo angina and + MPI in inferolateral segment. Cath revealed III vessel + LM CAD, in stent restenosis (ISR) of LM/proximal LCX with LVEF 55% and patent LIMA to LAD. Patient underwent drug eluting balloon of LM/LCX and did well. Patient is now scheduled for PCI of recurrent DES ISR using rotational atherectomy and intravascular brachytherapy (IVBT).

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.


2012 Live Case Archives

Click here for live case archives from 2012

 

Faculty

Samin K. Sharma, MD
Samin K. Sharma, MD
Director, Cardiac Cath Lab and Intervention
Professor of Medicine
Co-Director, Cardiovascular Institute
The Mount Sinai Medical Center
New York, New York

 

Samin K. Sharma, MD, has disclosed the following relevant financial relationships: Speaker's Bureau: Boston Scientific Corporation, Abbott, The Medicines Company, Daiichi Sankyo, Inc., and Lilly USA, LLC.

Annapoorna S. Kini, MD
Director, Cardiac Cath Lab
The Mount Sinai Medical Center
New York, New York

 

Annapoorna S. Kini, MD, has no relevant financial relationships to disclose.

Sameer K. Mehta, MD
Sameer K. Mehta, MD
Voluntary Associate Professor of Medicine University of Miami-Miller School of Medicine Miami, Florida

 

Sameer K. Mehta, MD, has disclosed the following relevant financial relationships: Consulting Fees: The Medicines Company.



American College of Cardiology Foundation staff involved with this case have nothing to disclose.

Program Information

Learner Objectives

After watching a case, the learner should be able to:

  • Discuss the rationale for choice of access site in performing percutaneous coronary intervention
  • Detail considerations for stent selection
  • Discuss choice of antiplatelet therapy
  • Demonstrate the application of large, randomized drug-eluting stent clinical trials results within an interventional clinical practice

Target Audience
Cardiologists, interventional cardiologists, fellows, and cardiovascular technicians.

 Return to Top

Advertisement
Advertisement