TRANSRADIAL PRIMARY PTCA TO RCA

THIS IS AN INTERESTING CASE THAT I DID RECENTLY. 47 YEAR OLD MAN PRESENTED 4 HOURS CHEST DISCOMFORT. CORONARY RISK FACTORS ARE SMOKER AND HYPERTENSION. 12 LEAD ECG SHOWED ST ELEVATION IN INFERIOR LEADS. HIS HAEMODYNAMICS REMAINED STABLE. CRUSHED ASPRIN 300MG, CLOPIDOGREL 300MG AND SUBLINGUAL GLYCERINE TRINITRATE WAS GIVEN STAT TO PATIENT.

HE WAS TAKEN TO CATH LAB 50 MINUTES AFTER PRESENTATION. THE ARTERIAL ACCESS WAS FROM THE RIGHT RADIAL ARTERY. USING DIAGNOSTIC OPTITORQUE 5F DIAGNOSTIC CATHETER, THE LEFT AND RIGHT CORONARY ARTERIES WERE CANNULATED. THE LEFT CORONARY SYSTEM WAS ESSENTIALLY NORMAL.

THE RIGHT CORONARY ARTERY (RCA) WAS OCCLUDED WITH THROMBUS FROM THE PROXIMAL SEGMENT.

I THEN PROCEED TO PERFORM CORONARY ANGIOPLASTY OF RCA. THE RCA WAS ENGAGED WITH JR 3.5 6F GUIDING CATHETER. THE LESION WAS CROSSED EASILY USING COUGAR XT GUIDE WIRE. THROMBUS ASPIRATION WAS PERFORMED USING EXPORT CATHETER. I FOUND MINIMAL AMOUNT OF RED THROMBUS. THE LESION WAS PREDIALATED WITH SPRINTER LEGEND 2.0X10MM INFLATED AT 12 ATM

I PROCEED WITH STENTING USING ENDEAVOUR 2.5X30MM STENT DEPLOYED AT 14 ATM. THE IMMEDIATE ANGIOGRAHIC RESULTS WAS GOOD WITH NO RESIDUAL STENOSIS, TIMI III FLOW FLOW AND TMP III MYOCARDIAL BLUSH

THE DOOR TO BALLON TIME WAS 65 MINUTES. THE RADIAL ACCESS SHEATH WAS REMOVED AND NICHIBAN WAS APPLIED FOR HAEMOSTASIS. 

THE PATIENT WAS NURSED IN ICU OVERNIGHT. 12 LEAD ECG SHOWED COMPLETE ST RESOLUTION AND HIS CK PEAKED AT 871U/L. HE WAS DISCHARGED WELL ON DAY 3 ADMISSION.

HIS MEDICATIONS UPON DISCHARGED ARE

1. CLOPIDOGREL 75MG DAILY

2. CARDIPRIN 100MG DAILY

3. ATORVASTATIN 80MG DAILY

4. RAMIPRIL 10MG BD