Elderly Patient with Complex Coronary Artery Disease Receives Timely Intervention

By Dr. Shalini Garg in Metro MAS Hospital, Jaipur, Rajasthan

A 76-year-old male presented with severe chest pain accompanied by sweating for the past 12 hours, along with feelings of uneasiness. The initial electrocardiogram (ECG) revealed sinus bradycardia and diffuse ST segment depressions in the anterior precordial leads. The troponin T test was positive, indicating cardiac damage. The patient underwent a coronary angiogram (CAG), which revealed left dominant circulation with a bifurcation lesion in the distal left main coronary artery (LMCA) (Medina 1,1,1) with 99% stenosis and the presence of a thrombus. Additionally, there was a 90% stenosis in both the ostial left anterior descending artery (LAD) and the ostial left circumflex artery (LCX). The attendants were informed about the serious prognosis, and the patient was taken for percutaneous transluminal coronary angioplasty (PTCA).

The PTCA procedure involved using the mini-crush technique to treat the LMCA to LAD and LMCA to LCX lesions with the insertion of two drug-eluting stents. Thankfully, the procedure was successful without any complications.

After two days of hospitalization, the patient was discharged in a stable condition. The complexity of this case was due to the left dominant circulation and the critical 99% stenosis in the distal LMCA. The lesion crossing required special attention as complete circulation to the heart was temporarily interrupted. The procedure had to be meticulously performed with a high level of precision and speed.

Dr Shalini Garg
MD (Goldmedalist) DM Cardiology
Senior consultant interventional cardiology
Metro MAS Hospital, Jaipur