class: center, middle, inverse, title-slide # Cath Conference ## JBVA Cardiac Catheterization Lab ### Anish Sanjay Shah, MD<br><span style="font-size: 70%;">Cardiology Fellow<br>University of Illinois at Chicago</span> ### October 12, 2021 --- class: center, middle, inverse # Case 1 70M h/o DM, HTN, CVA, PE, ETOH abuse p/w unstable angina, typical symptoms EST s- evidence of ischemia --- background-image: url("a4682-1-femoral.gif") background-size: contain --- background-image: url("a4682-2-rca.gif") background-size: contain --- background-image: url("a4682-3-rca.gif") background-size: contain --- background-image: url("a4682-4-rca.gif") background-size: contain --- background-image: url("a4682-5-lca.gif") background-size: contain --- background-image: url("a4682-6-lca.gif") background-size: contain --- background-image: url("a4682-7-lca.gif") background-size: contain --- background-image: url("a4682-8-lca.gif") background-size: contain --- background-image: url("a4682-9-lca.gif") background-size: contain --- background-image: url("a4682-10-lad-wired.gif") background-size: contain --- background-image: url("a4682-11-lad-ballooned.gif") background-size: contain --- background-image: url("a4682-12-lad-ballooned.gif") background-size: contain --- background-image: url("a4682-13-lad-stent.gif") background-size: contain --- background-image: url("a4682-14-lad-distal-bad.gif") background-size: contain --- background-image: url("a4682-15-lad-mid-stent.gif") background-size: contain --- background-image: url("a4682-16-lad-distal-stent.gif") background-size: contain --- background-image: url("a4682-17-lad-distal-stent-opened.gif") background-size: contain --- background-image: url("a4682-18-final.gif") background-size: contain --- .pull-left[ ### Access Right Radial, 5F Right Femoral, 6F JR 4, JL 3.5, 5F XB 4 Guide, 6F BMW x 1 ### Interventions Predilation of mLAD Stent placement proximally Rewire into dLAD, additional stent placement ] .pull-right[ ### Outcomes - Successful stent placement and flow in LAD - 2.5 x 34 mm DES to mLAD - 2.25 x 38 mm DES to dLAD ] --- class: center, middle, inverse # Case 2 68M h/o CVA, necrotizing myositis, OSA, DMT2, prostate CA p/w urosepsis, with episodes of NSVT LHC/COR: diagnostic angiogram with severe ostial RCA disease --- background-image: url("d8147-1-femoral.gif") background-size: contain --- background-image: url("d8147-2-engaging-rca.gif") background-size: contain --- background-image: url("d8147-3-shockwave.gif") background-size: contain --- background-image: url("d8147-4-rca-ostia.gif") background-size: contain --- background-image: url("d8147-5-stent-position.gif") background-size: contain --- background-image: url("d8147-6-aorta-delineation.gif") background-size: contain --- background-image: url("d8147-7-stent.gif") background-size: contain --- background-image: url("d8147-8-final.gif") background-size: contain --- .pull-left[ ### Access Right Femoral, 6F AL 0.75 Guide, 6F BMW, Wiggle, and Sion Blue ### Interventions IVUS to evaluate proximal/ostial lesion Shockwave IVL DES placement Post-dilation ] .pull-right[ ### Outcomes - Successful stent placement to ostial RCA lesion - Calcium modification with Shockwave IVL 4.0 x 12 mm - 4.0 x 38 mm DES to mLAD ] --- class: center, middle, inverse # Case 3 77M h/o CAD s/p PCI to LAD/OM1 (2013) h/o OSA on BIPAP, obesity, HTN, HLD, CKD 3, DVT p/w newly reduced EF to ~30% c/s LHC/RHC/COR --- background-image: url("p5517-1-lost.gif") background-size: contain --- background-image: url("p5517-2-femoral.gif") background-size: contain --- background-image: url("p5517-3-still-lost.gif") background-size: contain --- background-image: url("p5517-4-lca-rao-caud.gif") background-size: contain --- background-image: url("p5517-5-lca-rao-cran.gif") background-size: contain --- background-image: url("p5517-6-lca-rao-cran.gif") background-size: contain --- background-image: url("p5517-7-lca-lao-cran.gif") background-size: contain --- background-image: url("p5517-8-lca-lao-caud.gif") background-size: contain --- background-image: url("p5517-9-lca-lao-caud.gif") background-size: contain --- background-image: url("p5517-10-rca.gif") background-size: contain --- background-image: url("p5517-11-rca.gif") background-size: contain --- .pull-left[ ### Access Right Radial, 5F Right Femoral, 6F JR 4, 6F JL 5, 6F ### Interventions Escalation of engagement catheters ] .pull-right[ ### Outcomes - Non-ischemic etiology of newly reduced EF - Nonobstructive CAD, calcific/chronic - Mild ISR of prior LAD stent ] --- class: center, middle, inverse # Case 4 61M h/o septic endocarditis s/p MVR (2014) p/w ADHF TTE/TEE c- severe MS c/s preoperative angiogram --- background-image: url("w2171-1-lca.gif") background-size: contain --- background-image: url("w2171-2-lca.gif") background-size: contain --- background-image: url("w2171-3-lca.gif") background-size: contain --- background-image: url("w2171-4-lca.gif") background-size: contain --- background-image: url("w2171-5-rca.gif") background-size: contain --- .pull-left[ ### Access Left Radial, 5F Terumo Tiger, 5F ### Interventions None ] .pull-right[ ### Outcomes - Nonobstructive CAD, diminutive AV LCX - Short LCX with high caliber OM system s/p SMVR - High bifurcation of the RPDA ]