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      Friday, June 9, 2023
      News & Perspective Drugs & Diseases CME & Education Academy Video Decision Point
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      References

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      Archived Cases
      • A 65-year-old Man Undergoes Staged Intervention of Calcific LAD/Diagonal Bifurcation
        A 65-year-old man with multiple risk factors for CAD and stage IV chronic kidney disease presented on May 17, 2012 with new-onset CCS class III angina. Cardiac catheterization revealed extensive calcific 3-vessel CAD and normal LV function with a Syntax Score of 45. CABG was recommended; however, the patient declined CABG and underwent Rota DES PCI of the circumflex-OM1 branch using a Xience Prime stent. Now he is scheduled for staged intervention of calcific LAD/diagonal bifurcation.
        Jun 29, 2012
      • A 67-Year-Old Man Undergoes PCI of Distal LM Trifurcation Lesion
        A 67-year-old man with multiple risk factors for CAD presented on April 17, 2012 with new-onset CCS class III angina and a positive ETT (Duke treadmill score -10). Cardiac catheterization revealed 3-vessel and LM CAD and normal LV function; Syntax score was 31. CABG was recommended but the patient declined the procedure and underwent PCI of the subtotal mid RCA using a Promus Element DES. He is now planned for PCI of his distal LM trifurcation lesion.
        May 30, 2012
      • A 68-Year-Old Man With Previous CABG and AVT Undergoes PCI of Stenosed SVG
        A 68-year-old man with 1 prior CABG and AVR in 2005 presented with new-onset crescendo angina CCS class III. A myocardial perfusion imaging stress test revealed large anteroapical and moderate inferolateral ischemia. Cardiac catheterization on March 20, 2012 revealed 3-vessel CAD of stenosed SVG to OM1 with normal LV function and a normal aortic bioprosthesis. He underwent successful intervention of culprit mid and distal LAD using Xience V DES and Tryton BMS in D2 as part of the Tryton Bifurcation IDE Study. The treatment plan now is for PCI of SVG to OM1.
        Apr 27, 2012
      • A 61-Year-Old Woman Undergoes IVUS-guided PCI of Unprotected Left Main Bifurcation
        A 61-year-old woman with history of prior PCI of RCA and LAD presented with crescendo angina, CCS class III. No stress test was done. Cardiac cath on March 2, 2012 revealed 2-vessel and left main bifurcation disease with normal LV function and SYNTAX score of 23. CABG was declined due to liver cirrhosis. The treatment plan now is for IVUS-guided PCI of unprotected left main bifurcation.
        Mar 29, 2012
      • A 57-Year-Old Man Undergoes Staged PCI of a Native RCA CTO
        A 57-year-old man with a history of CABG, x2 in 1990, presented with new-onset angina and moderate inferior and mild septal ischemia on stress MPI and catheterization on January 15, 2012, which revealed 3-vessel CAD, patent LIMA to LAD, occluded SVG to RCA and normal LV function. Native RCA is totally occluded in its mid segment and fills via bridge collaterals and retrograde collaterals via 90% stenosed large first septal branch. Patient underwent DES of first septal branch but angina persists despite maximal medical therapy. Patient is now planned for PCI of native CTO RCA via antegrade or retrograde technique.
        Feb 29, 2012
      • A 77-Year-Old Man With Prior DES PCI of Culprit RCA Undergoes FFR-Guided PCI of LAD and/or LMCA
        A 77-year-old man presented with non-STEMI. Cardiac catheterization on August 30, 2011 revealed 3-vessel CAD (95% ostial RCA, 50% distal LM, 70% to 75% multiple lesions in LAD, and 70% OM2) and near-normal systolic LV function. Patient underwent PCI of culprit RCA vessel using Xience® V DES. The patient now has crescendo angina and the treatment plan is for FFR-guided PCI of LAD and/or LMCA.
        Jan 27, 2012
      • An 86-Year-Old Woman With Prior DES PCI of Mid-LAD Undergoes Rotablation and DES of Complex Calcified Lesions
        An 86-year-old woman with prior DES PCI of mid-LAD presented with CCS class IV angina. Cardiac catheterization on October 21, 2011 revealed 3-vessel CAD and normal LV function and new culprit 90% lesion in distal LAD. Patient underwent PCI of distal LAD using Xience® V DES. The treatment plan now is for rotablation and DES for complex calcified ostial and distal RCA lesions.
        Dec 28, 2011
      • 72-Year-Old Woman Undergoes High-Risk PCI of Complex Calcified Bifurcation LAD/D1/D2 Lesions Using Rotational Atherectomy and DES With Impella® LV Assist Device
        72-year-old woman with progressive dyspnea and crescendo angina presented on October 14, 2011. Cardiac catheterization revealed mild pulmonary hypertension, minimal aortic stenosis, 2-vessel CAD (RCA and LAD), and LVEF 25%. Patient underwent PCI of RCA using Xience® V DES. The treatment plan now is for high-risk PCI of complex calcified bifurcation LAD/D1/D2 lesions using rotational atherectomy and DES with Impella® LV assist device.
        Nov 29, 2011
      • A 72-Year-Old Woman With 2-Vessel CABG in 1985 Undergoes Staged PCI of the Native LAD via LIMA
        A 72-year-old woman who had 2-vessel CABG in 1985 presents with angina (CCS class III) and high-risk findings on a stress MPI for multivessel ischemia. Cardiac catheterization on June 6, 2011 revealed 3-vessel + LM CAD, patent LIMA to LAD with 90% lesion in native LAD after anastomosis, patent SVG to RCA, and 95% lesion in native LPL. LVEF is 60%. The patient underwent PCI of LM and LPL using Promus® DES. The treatment plan now is for staged PCI of the native LAD via LIMA.
        Oct 27, 2011
      • A 68-year-old Man With Calcified Distal Left Main and Circumflex Disease Undergoes PCI of the Unprotected Left Main Coronary Artery
        A 68-year-old man with prior PCIs in 1999 has crescendo angina and high-risk stress MPI for multivessel ischemia. Cardiac catheterization revealed calcified distal left main and circumflex disease (SYNTAX Score 16) and moderate LV dysfunction (LVEF 40%). The treatment plan now is for PCI of the unprotected left main coronary artery.
        Sept 27, 2011
      • A 51-Year-Old Man Undergoes Complex PCI of Mid-RCA, RPDA, and RPL
        A 51-year-old man with prior PCIs in 2004-2006 presented with crescendo angina and high-risk stress echocardiogram for multivessel ischemia. Cardiac catheterization revealed 2-vessel CAD (95% proximal LAD; TAXUS® DES ISR and 80%-90% calcified mid-RCA with distal branch diseases). Patient underwent atherectomy using AngioSculpt® balloon and re-DES using XIENCE V® of proximal LAD. The treatment plan now is for complex PCI of mid-RCA, RPDA and RPL.
        August 2011
      • A 78-Year-Old Man Undergoes Staged Intervention of Calcific LAD and Diagonal Lesions
        A 78-year-old man presented with crescendo exertional angina (Canadian Cardiovascular Society [CCS] class III) and shortness of breath for 1 month. The patient had recent gastrointestinal bleeding requiring a blood transfusion. Upper endoscopy revealed a duodenal ulcer. Cardiac catheterization on May 17, 2011 revealed 2-vessel coronary artery disease (D2 and right coronary artery) with a normal left ventricular ejection fraction. The patient underwent successful percutaneous coronary intervention of D2 with a cobalt-chromium bare metal stent. The treatment plan now is for staged intervention of multiple calcified lesions in the right coronary artery, again with a bare metal stent due to gastrointestinal bleeding.
        August 2011
      • An 88-Year-Old Man Undergoes Staged Intervention of Calcific LAD and Diagonal Lesions
        An 88-year-old man (with IDDM, CRI, CVA, PVD, and COPD) presented on May 10, 2011 with NSTEMI. Cardiac catheterization revealed 3V+LM CAD (SYNTAX score 44) and severe LV dysfunction (LVEF 20%). CABG was recommended but declined because of multiple comorbidities. The patient underwent successful PCI (Rota-DES) of culprit mid-RCA lesion using Xience V® DES (4.0 x 23 mm). He is now undergoing staged intervention of calcific LAD and diagonal lesions with the Impella Recover® 2.5 assist device.
        June 29, 2011
      • Radial Approach: A 63-Year-Old Woman Undergoes Staged FFR/IVUS-Guided PCI of RCA and Circumflex
        Radial approach: A 63-year-old woman with diabetes presented on April 1, 2011 with crescendo angina and shortness of breath (no stress test). Cardiac catheterization revealed 3-vessel CAD (SYNTAX Score 27) and normal LV function. Patient underwent PCI of multiple calcific LAD lesions using ROTA DES. The treatment plan now is for staged FFR/IVUS-guided PCI of RCA (1 lesion) and circumflex (2 lesions).
        May 25, 2011
      • Radial Approach: A 62-Year-Old Man Undergoes Complex PCI of Calcific RCA and Circumflex LPL
        Radial approach: A 62-year-old man with diabetes presented on March 8, 2011 with unstable rest angina. Cardiac catheterization revealed extensive 3-vessel calcific CAD (SYNTAX score 32) and mild LV dysfunction. Patient underwent PCI of LAD-diagonal using Rota-DES. The treatment plan now is for staged PCI of calcific RCA and circumflex LPL via a radial approach.
        Apr 26, 2011
      • Radial Approach: A 68-Year-Old Man Undergoes Complex PCI of Calcific RCA and LAD/D2 Bifurcation Lesions
        Radial Approach: A 68-year-old man with diabetes and extensive peripheral vascular disease underwent cardiac catheterization, which revealed extensive 3-vessel coronary artery disease (SYNTAX score 19) and normal left ventricular function. The patient underwent percutaneous coronary intervention (PCI) of the circumflex artery (proximal and OM1) using the Xience® V DES. The current plan is to perform complex high-risk PCI of calcific right coronary artery (proximal, mid, distal) and calcific left anterior descending artery (LAD)/D2 bifurcation (Medina 0,1,1) lesions via a radial approach.
        March 23, 2011
      • A 90-Year-Old Woman Undergoes PCI of LM and LAD/D1 Bifurcation Lesions
        A 90-year-old woman presented with a non-ST-elevation myocardial infarction on December 23, 2010. Catheterization revealed extensive 3-vessel coronary artery and left main disease (SYNTAX score, 40) with normal systolic left ventricular function. The culprit lesion was a thrombotic in-stent restenosis of the midright coronary artery bare metal stent. The patient underwent successful percutaneous coronary intervention (PCI) with high-pressure balloon dilation and cutting-balloon PCI. She did well with class II symptoms and now presents for staged PCI of the left system. The current treatment plan is PCI of the left main and left anterior descending arteries/first diagonal bifurcation lesions (Medina 1,1,1). SYNTAX score is 31.
        Feb 25, 2011
      • A 64-Year-Old Man Undergoes Complex PCI of Subtotal Mid-LAD and Diagonal Bifurcation Lesion
        A 64-year-old man presented with non-ST-segment elevation MI on November 2, 2010. Catheterization results revealed 3-vessel coronary artery disease and mild left ventricular dysfunction. The patient underwent successful percutaneous coronary intervention (PCI) of a complex right coronary artery occlusion using 2 bare metal stents. Now complex PCI is planned for a subtotal mid-left anterior descending and a diagonal bifurcation lesion (Medina 1,1,0) causing moderate-to-severe anterior wall ischemia, along with PCI of a distal circumflex occlusion.
        February 2011
      • A 78-Year-Old Man Undergoes Staged PCI of LAD/Diagonal Bifurcation Lesion
        A 78-year-old man presented with crescendo angina and intermediate-risk multivessel ischemia on stress perfusion imaging. Cardiac catheterization on November 12, 2010 revealed 3-vessel CAD (SYNTAX Score 31) and normal LV function. Patient underwent successful PCI of subtotal circumflex-OM2 using Xience® V DES. Now scheduled for staged PCI of LAD/diagonal bifurcation lesion (Medina 1,1,1) and Rotablator PCI of multiple calcific lesions of RCA, including distal bifurcation lesion (Medina 1,0,1).
        January 2010
      • An 83-Year-Old Woman Undergoes Complex PCI of Calcific Left Anterior Descending and Left Main Arteries
        An 83-year-old woman presented on November 5, 2010 with non-ST-segment elevation myocardial infarction and congestive heart failure. Catheterization revealed 3-vessel and left main disease with a left ventricular ejection fraction of 30%. The patient underwent culprit vessel percutaneous coronary intervention (PCI) of the right coronary artery and is now scheduled for complex PCI of calcific left anterior descending artery and left main with the Impella Recover® 2.5 LV Assist Device. Dr. Pedro Moreno, Director of Interventional Cardiology Research at The Mount Sinai Medical Center joins the team in the cath lab for this month's case.
        December 2010
      • An 89-Year-Old Woman Undergoes Staged PCI of LM Bifurcation and LAD Artery
        An 89-year-old woman presented with posterior and lateral wall STEMI on September 10, 2010. Cardiac catheterization revealed 3-vessel CAD with left main bifurcation disease and LVEF 40% (SYNTAX score 28). Patient underwent primary PCI of circumflex-OM with IABP support and did well subsequently. Staged PCI of left main bifurcation and LAD are planned. Dr. Roxana Mehran joins Drs. Sharma and Kini in the cath lab for this case.
        November 2010
      • A 72-Year-Old Man Undergoes Complex PCI of Calcific Proximal LAD and Circumflex (Bifurcation Stenting) Arteries
        A 72-year-old man presents with Canadian Cardiovascular Society class II angina and high-risk multivessel ischemia on stress myocardial perfusion imaging study. Catheterization revealed 3-vessel coronary artery disease, normal left ventricular function, and a SYNTAX score of 26. The patient is status post percutaneous coronary intervention (PCI) of subtotal right coronary artery on 8/6/10. He is now admitted for complex PCI of calcific proximal left anterior descending (using Rotablator®) and circumflex (bifurcation stenting) arteries.
        October 2010
      Program Information
      • Learning Objectives
        • 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, cardiovascular technicians, and cath lab nurses.
      Supported by an independent educational grant.
      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
      • Listen to interview
      • Annapoorna S. Kini, MD Annapoorna S. Kini, MD
        Director, Cardiac Cath Lab, The Mount Sinai Medical Center, New York, New York
      • Listen to interview
      • Sameer K. Mehta, MD Sameer K. Mehta, MD
        Voluntary Associate Professor of Medicine, University of Miami - Miller School of Medicine, Miami, Florida
      • Listen to interview
      Disclosures
      • Samin K. Sharma, MD
        Samin K. Sharma, MD, has disclosed the following relevant financial relationships: Served as a speaker or a member of a speakers bureau for: Abbott Vascular, Boston Scientific, Eli Lilly and Company, The Medicines Company
      • Sameer K. Mehta, MD
        Sameer K. Mehta, MD, has disclosed the following relevant financial relationships: Served as an advisor or consultant for: Abbott Laboratories; The Medicines Company
        Employed by a commercial interest: The Medicines Company
      • Annapoorna S. Kini, MD
        Annapoorna S. Kini, MD, has no relevant financial relationships to disclose.
      • Caroline M. Padbury, B.Pharm
        Senior Scientific Director Medscape/theheart.org

        Caroline M. Padbury has disclosed no relevant financial relationships.
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