Complex percutaneous coronary interventions (PCI) are performed in challenging anatomic territories such as left main, bifurcations and chronic total occlusions. The successful angiographic result is based on the technical expertise and experience of the operator. Mastering the techniques of complex interventions and gaining experience can only occur in high volume centers ( > 4000 operations / year) where operators are exposed in different degree of complexity.
Dr Gogas is certified complex operator selected as international talent to receive elite training at the center of excellence in interventional cardiology “The Spencer B. King III Catheterization Laboratory” lead by the world-renowned leader in Interventional cardiology: Prof. Shao-Liang Chen.
Case example from Metropolitan General: Ostial Left Main PCI presenting as Cardiac Arrest
A 70-year-old female with a recent history (6-months) of surgical aortic valve replacement (SAVR) with a 19-mm Bicarbon Slimline Livanova metallic prosthesis (LivaNova PLC, Saluggia, IT) presented with crushing chest pain. A positive troponin test combined with electrocardiographic evidence of diffuse ST depression in leads II, aVf, V3-V6 (Fig 1) and ST elevation in aVr suggested a diagnosis of non-ST elevation myocardial infarction necessitating evaluation in the cardiac catheterization laboratory in anticipation of INR drop below 1,8 (~ 2.8 during admission).
The aforementioned plan was aborted as the patient experienced cardiac arrest shortly after admission and was urgently transferred to the catheterization laboratory following successful resuscitation and intubation. Angiographic evaluation through the right trans radial access demonstrated ostial left main occlusion and patent saphenous vein graft to distal right coronary artery (RCA).
Left main engagement was managed with a JL 4.0 6F guide catheter and the ostial lesion was crossed with a BMW guidewire (Abbott Vascular, Santa Clara, USA). Predilatations were performed with 3.0 x 15 mm compliant balloon and a Xience Pro 3.5 x 15 mm (Abbott Vascular, Santa Clara, USA) drug-eluting stent was deployed. Following successful stent deployment proximal optimization was performed with a 4.0 x 15 mm non-compliant balloon at high atmospheres delivering an excellent angiographic result.
