LCX_thrombus_migration_to_LM_LAD

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LCX thrombus migration to LM/LAD Dr N O Bansal DM, DNB, FSCAI, FESC Professor and Head, Department of Cardiology at Grant Medical College and Sir J J Group of Hospitals, Mumbai. Honorary Cardiologist to Governor of Maharashtra. President Elect CSI - Mumbai Chapter .

CASE HISTORY / RISK FACTOR:

55 year old male. Recently diagnosed DM. Non HTN. Non addict. Admitted with USA II b. P – 72/min BP – 130/80 mm Hg CVS- S1S2 normal, no murmur RS – clear CASE HISTORY / RISK FACTOR

CASE HISTORY / RISK FACTOR:

ECG showed old IWMI with poor R from V1 toV4 and troponin T was positive. On 2DECHO -- IW and PW hypokinesia with LVEF=40%. CAG LAD- mid 60% lesion f/b 60 % lesion LCX- long segment 70% lesion with involvement of OM1/OM2 RCA- NORMAL. PDA- prox 80% lesion Patient first underwent PDA stenting and then taken up for LCX plasty CASE HISTORY / RISK FACTOR

LCX lesion wired and balloon dilated and stented – pronova 2.75 x 38mm:

LCX lesion wired and balloon dilated and stented – pronova 2.75 x 38mm

Post stent dilatation – no flow in LCX:

Post stent dilatation – no flow in LCX

Stent redilated with 2.75 NC balloon- thrombus shifted to LAD/LM Thrombosuction was done to LCX followed by LAD/LM:

Stent redilated with 2.75 NC balloon- thrombus shifted to LAD/LM Thrombosuction was done to LCX followed by LAD/LM

LAD stented first- pronova 2.75 x 32:

LAD stented first- pronova 2.75 x 32

LCX instent tackled with NC balloon:

LCX instent tackled with NC balloon

Flow establised in LAD and LCX:

Flow establised in LAD and LCX

TAKE HOME:

TAKE HOME Thrombus migration to left main can be LIFE THREATENING. In left system plasty it is a must to pay attention to both LAD and LCX -----thrombus may shift to other arteries including LM. Thrombus aspiration is of great help to decrease the thrombus load and to improve the flow. With long stents post stent dilatation should be practiced routinely. Most important - “ DO NOT PANIC”

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