Native Vessel Intervention with Embolic Protection Using the PercuSurge GuardWire

- Operator : Charles Chan

Native Vessel Intervention with Embolic Protection Using the PercuSurge GuardWire
- Operator : Charles Chan, MD
Case Presentation
The patient was 52 year-old male. He presented with ST segment elevation acute myocardial infarction on anterior leads. He was treated with urokinase four hours after an onset of chest pain. The chest pain and EKG change disappeared one hour after an intravenous administration of urokinase. He had a hypertension as a coronary risk factor. Echocardiography showed near normal LV ejection fraction of 52% with wall motion abnormality of LAD territory. Coronary angiogram was performed two days after admission.
Baseline coronary angiography
1. Coronary angiogram showed mid LAD bifurcation lesion with TIMI 3 flow. LAD had an intralumunal filling defect indicating thrombus overlying the lesion (Figure 1 and Figure 2).

2. LCX and RCA were normal

Procedure
A 7F sheath was inserted through right femoral artery and the left coronary was engaged with a 7F Judkins catheter. 0.014" Choice PT wire was placed into diagonal branch. And then, a distal protection device (PercuSurge GuardWire®) was deployed into LAD to prevent distal embolization following intervention. The large burden of thrombus in the LAD was initially aspirated using an export catheter without distal protection. After the initial aspiration, angiogram revealed reduced burden of thrombus and new developed haziness in mid and distal LAD suggesting a dissection (Figure 3). Once complete distal occlusion of distal LAD was verified with contrast injection, predilatation was performed with 20 mm x 3.0 mm balloon at 8 atm two times. After predilatation, aspiration of embolic debris with Export catheter was done. Following angiogram revealed a diffuse 70% luminal narrowing in mid LAD after deflation of distal protection balloon. A 24 mm x 3.0 mm S7 stent was implanted in the mid LAD lesion under distal protection (Figure 4). Following stent implantation, the stagnant blood and debris in the LAD were aspirated using an export catheter. Final angiogram showed successful stent implantation in the mid LAD without residual stenosis or dissection and presence of mild narrowed diagonal branch (Figure 5). There was no evidence of distal embolization. Cardiac enzymes remained in the normal range and the patient discharged two days later. The apirated material was composed of thrombus and atheroembolic debris.

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