Complication in angioplasty

1
Complication in angioplasty

• The case I dont want to have again
• MC Morice, Massy France

2
Syncope with chest pain 2 hours before admission
DR, m 60y
Cardiovascular risk-factors

• Smoking history
• Hypertension
• Diabetes mellitus

Cardiovascular history

• Ischemic stroke (1980, without neurological
  sequel)

STEMI with persistent elevation ST inferior and
lateral
3
ECG before PCI

• Inferior and Lateral ST segment elevation
• Syncope, no chest pain
• No clinical signs of shock

4
Angiogram
OM1 50-70. Proximal RCA 100
5
Primary Angioplasty RCA occlusion
Radial approach. AL1 6F
BHW wire EXPORT thrombectomy system
Result
6
Angioplasty 2
Dilatation Maverick 2/12mm ballon (10 atm)
BHWBMW wires.
Result
7
Angioplasty 3
Stent DRIVER 3.0/30 mm (10 atm)
Result
8
Angioplasty 4
Intrastent x3 dilatation Mercury NC 3.0/10mm
ballon (max 30 atm)
Temporary pacemeker for third degree AV block
9
Angioplasty 5
Stent MICRO DRIVER 2.5/18
Stent DRIVER 3/24
Stent MICRO DRIVER 2.25/24

IC Verapamil
10
Final result
Unsuccessfull primary angioplasty RCA occlusion
Instable hemodynamic state Intra-aortic ballon
pumping
11
After failed angioplasty

• Clinical signs of Cardiogenic shock requiring

• Tracheal intubation
• Inotropic support
• Intra-aortic ballon pumping
• Temporary pacemaker

• Echocardiography
• LVEF lt30, akinetic inferolateral segments of LV
• RV akinetic

12
ECG post angioplasty
13
After 2 days on ICU
Progressive multi-organ failure

• PCI Treatment of OM1
• Implantation of an Left ventricular assist
  IMPELLA

14
Final evolution

• Final evolution
• Slow recovery to a Stable hemodynamic state

• Echocardiography
• Improved LVEF 50 inferoapical akinesia

Hospital discharge 1 month after PCI
15
ECG after PCI obtuse marginale
ECG before discharge
16
Summary

• Clinical case IMPELLA in cardiogenic shock

• Primary angioplasty is not always succesful
  despite the use of thrombectomy and stenting and
  as in our case can result in clinical
  deterioration
• Intra-aortic ballon pumping is not very effective
  in RV failure
• The Impella device can be useful?