HEAPHY 1

1
HEAPHY 1 2 CASE RACE 1 DIAG Rowena OLIVER
Sat 31st Aug 2013 Session 3 / CR1-6 1326 1330

• OTAGO / SOUTHLAND
• ABSTRACT
• A case of a 81 year old female previous history
  of Coronary artery disease with CABG. presenting
  with chest pain and troponins raise.  Send to
  Cath Lab for coronary and grafts angiography to
  determine cause of chest pain. What could go
  wrong with a routine procedure?

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THINGS ALWAYS GET WORSE BEFORE THEY GET BETTER

• ROWENA OLIVER NDIMDI
• STAFF MRT
• DUNEDIN RADIOLOGY
• DUNEDIN HOSPITAL

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PATIENT HISTORY

• 81year old female
• Previous history of
• unstable angina
• 10 years post Coronary Artery Bypass Graft
  surgery (C.A.B.G) - 3 vessel grafts
• Presented with prolonged chest pain.
• Transferred from
• Southland Hospital to Dunedin Hospital.
• Referral for Cardiac Angiography

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PATIENT PREPARATION

• Informed consent was given.
• Procedure benefits of Cardiac Angiography
• - Diagnosis
• - Stents
• Alternatives and risk including but not limited
  to
• - Heart attack
• - Death
• - Stoke
• - Lost of limb
• - Vessel injury
• - Contrast reaction
• - Bleeding
• - Infection
• - Open heart surgery
• - Renal failure

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Left Internal Mammary Artery (LIMA)Graft to Left
Anterior Descending Artery (LAD)
Left Internal Mammary Artery (LIMA)
Left Anterior Descending Artery (LAD)
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Catheter Kink in Origin of Left Radial Arteryto
Brachial Artery
CATHETER KINK
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Right Femoral Artery Approach to Left Subclavian
Artery
LIMA CATHETER
Guiding Catheter
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Right Femoral Artery approach to Left Subclavian
Artery with Goose Neck Snaring of LIMA Catheter
VERTEBRAL ARTERY
LIMA CATHETER
SNARE
CAROTID SHEATH
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LIMA Catheter Snared and Removal
CAROTID SHEATH
LIMA CATHETER SNARED
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martyink.com 23/07/2013
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Antegrade and Retrograde Imaging
VERTEBRAL ARTERY
DISSECTION FLAP
OCCLUSION
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Ballooning Positioning of Stent in Subclavian
Artery
8mm x 4cm BALLOON
8mm x 4cm STENT
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Deployment of Stent
Partly Deploy Stent
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Post Stent Deployment
VERTEBRAL ARTERY
50 Stenosis
LIMA
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onwardstate.com 27/07/2013
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Perforation and Extravasation
Perforation
Extravasated Contrast

• Previous

• Post

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Post Covered Stentsof Radial-Brachial Arteries
COVERED STENT
gefaesszentrum-bochum.com- 26/07/2013
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ACKNOWLEDGEMENTS

• The Anonymous Professor of Cardiology
• Cardiology, Radiology Team
• Dunedin Hospital

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