Coronary Angioplasty (Mr AD)

Mr DD was experiencing gripping chest pain on exertion. This thought to be secondary to coronary artery disease (inadequate blood supply to the heart). He had a coronary angiogram that revealed narrowing in blood vessels supplying the heart. It demonstrated severe narrowing of the left circumflex and right coronary artery He went on to have these treated by percutaneous (through the blood vessel in the right arm) coronary angioplasty. Both coronary arteries were treated at the same time. - The right coronary artery was treated by initially relieving the narrowing with balloons followed by deployment of two drug eluting stents (2.75mm and 3.0mm diameter) that overlapped. The stents were optimised using balloons with intravascular ultrasound guidance. - The left circumflex artery was treated by initially relieving the narrowing with balloons followed by deployment of two drug eluting stents (2.75mm and 3.0mm diameter) that overlapped. The stents were optimised using balloons.

Mr GD started experiencing severe chest pain. When the ambulance service arrived they noted abnormalities on his ECG suggestive of a heart attack (ST segment elevation myocardial infarction). Therefore he was brought as an emergency to the cardiac catheterisatiojn lab. On arrival he was reviewed by the interventional cardiology team who though he was having a ongoing heart attack. He had coronary angiogram that revealed a blocked blood vessel supplying the heart that was causing his symptoms. It demonstrated blockage of the left circumflex coronary artery- one of the arteries supplying heart. This was treated with percutaneous (through the blood vessel in the right arm) coronary angioplasty as an emergency. This was performed by relieving the blockage with the use of a coronary angioplasty guide-wire into the blood vessel and then deployment of a drug eluting stent (3mm diameter) to his left circumflex coronary artery. It was also noted in addition to the block blood vessel (treated as an emergency) the patient had severe narrowing in other blood vessels, these were treated at a later date without complication.

JB, a female aged 79, was admitted with on-going anginal (chest) pain. As part of the diagnostic management, she underwent coronary angiography. The coronary arteries were visualised by placing a catheter through the right radial artery (in the wrist). The coronary angiogram showed multiple stenoses in the mid to distal (situated away from the origin of) left anterior descending coronary artery, as well as a tight stenosis in the circumflex branch. Subsequently she was offered a coronary artery bypass graft (CABG) which was withdrawn and angioplasty was provided instead. The procedure was performed a few months later during which she had a cutting balloon (Flextome) angioplasty followed by the stent (Euphora: 3.0mm x 12mm) insertion in the circumflex artery. Interventional treatment was successful.

MN, a male aged 46, had been suffering from left-sided chest pain which may not be related to exertion. He has a very strong family history of coronary artery disease. He also has a background of high cholesterol, obesity, diet controlled diabetes and he is an ex-smoker. Echocardiogram was performed which showed good left ventricular function. Before the coronary angiogram, he had a CT cardiac angiogram which showed occlusion of the first diagonal from the left anterior descending artery. From this, he was arranged a coronary angiogram through the right radial artery (in the wrist). The left anterior descending artery was catheterised with the Medtronic 6F EBU3.5 Launcher and a Verrata pressure wire was used to measure pressures across the lesions. When the distal diagonal branch was crossed with the Whisper MS wire, the stenosis was predilated with Euphora 2.0mm x 12mm and a drug eluting stent Xience PRO 2.25mm x 15mm was deployed. The interventional treatment was successful.

SA, a 59 year old male, underwent a coronary angiogram as part of the work up for a coronary artery bypass graft (CABG). He had a background of high blood pressure, obesity, ischaemic heart disease (with previous coronary angiogram) and smoking. He underwent a further coronary angiogram through the right radial artery (in the wrist) with a 6F TIG catheter. The test showed severe disease in the left circumflex and right coronary arteries, as well as a patent (opened) stent in the left anterior descending artery. Lesions were found to be suitable for angioplasty. The patient was referred back to the cardiothoracic surgeons for further discussion regarding his treatment.

PD, a male aged 64, presented with exertional shortness of breath, absent of chest pain. His medical background included high blood pressure, high cholesterol and a family history of coronary artery disease. He was offered to have a coronary angiogram through the right radial artery (in the wrist) using a TIG 5F Diagnostic catheter. The test revealed moderate ostial posterior descending artery stenosis which was crossed with a Verrata wire and no change in the pressures across the lesions were shown.