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Evolut R

Case 5 – Thrombotic LAD PCI

Case Presentation

  • An 81-year-old male with a history of CAD s/p multiple PCIs, Severe AS s/p SAVR and ViV TAVR (26 Evolut-R 2018), HTN, DM, and ex-smoker presented with acute onset of left sided chest pain and shortness of breath.
  • EKG showed NSR with TWI in V2 and labs showed elevated Troponin with peaked level of 5.6 ng/ml.
Right coronary artery angiogram was performed by using JR 4.
Left coronary artery angiogram was done non-selectively by 6F Ikari right 1.5 catheter and revealed a thrombotic occlusion of mid LAD. We used guide extension catheter (i.e. Guidezilla) with Ikari to perform PCI.
Successful PTCA of LAD was done with good angiographic result.

Learning Points

  • In VIV post TAVR case, the catheter engagement adds additional difficulty and Ikari 1.5 guide catheter should be used in those cases.
  • Coronary wire and guide extension catheter could facilitate a selective coronary engagement and provide additional support for coronary intervention.

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