74 m presents to Cath Lab following 1h slowly increasing che | Figure 1

Firstvictor

Technologist

74 m presents to Cath Lab following 1h slowly increasing chest pain while shopping in the evening. Pt was airlifted due to remote location. Left chest, arm, and jaw pain increased to 9/10 at ER arrival, minimally relieved by sublingual NTG. Pt received Zofran due to nausea. Heparin given. Note: pt has history of previous LAD infarction, chronic smoking, and diabetes type 2. Access was made in right femoral artery using 18g needle and 6F sheath. Extremely torturous vessels were found in the iliac, versacore wire was used to exchange short 6f sheath for long braided 6f sheath. JL4 diagnostic advanced to AO. AO pressure of 105/75. Mild narrowing indicative of ISR noted in mid LAD, 1st diag noted for TIMI 1 flow. Cath exchanged for JR4 guide cath, LV pressure recorded with EDP of 15, no gradient on pullback. RCA injection reveals distal RCA blockage. Prowater wire advanced followed by 2.0x12 euphoria balloon, immediate TIMI 3 flow in all distal vessels. Pt reports zero pain. EKG reverts to normal sinus without ST elevation. Noted dissection in posterior lateral. D2B time of 23 minutes. Second 300cm Prowater advanced to PL. Several balloons used. 3.0x18 onyx Stent placed, excellent result. RFA closure with angioseal. No complication. Final contrast 230ml. EBL minimal. Pt put on Plavix, transported to step-down. Discharged two days later. Follow up scheduled with PCP at future date.

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