Case 193: Manual of PCI - Emergent DK crush

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A patient presented with NSTEMI with ongoing chest pain and was referred for emergent coronary angiography. Angiography was performed via femoral access and showed occluded proximal LAD and a hazy lesion in the mid right coronary artery. Wiring of the LAD was challenging with a workhorse wire but eventually succeeded using a soft, polymer-jacketed wire. After predilatation antegrade flow was restored showing a bifurcation LAD/diagonal lesion. We used the DK crush technique to stent both vessels and IVUS to confirm that we achieved an optimal result.
The patient had improvement but no resolution of the chest pain. We decided to also stent the right coronary artery which was achieved using 4.5 mm DES.
Right heart catheterization showed a wedge pressure of 34 mmHg and cardiac index of 1.4 L/min/m2. Aortic pressure was 135/100 mmHg and heart rate was 130 bpm. An Impella CP was inserted into the LV and the patient was admitted to the CCU.
Category
Cardiology
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