Coronary Angioplasty (Mr DD)

Mr AD was suffering from symptoms of angina (chest pain due to an inadequate blood supply to the heart). He had a coronary angiogram that revealed narrowing in blood vessel supplying the heart that was causing his symptoms. It demonstrated severe narrowing of the left circumflex coronary artery. He went on to have this treated by percutaneous (through the blood vessel in the right arm) coronary angioplasty. This was performed by relieving the narrowing with balloons initially followed by deployment of two drug eluting stents (3mm and 2.5mm diameter) to his left circumflex coronary artery. The stents were optimised with intravascular ultrasound.

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.

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 Subsequently she was offered a coronary artery bypass graft (CABG) which was withdrawn and angioplasty was provided instead.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.

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.

SM, a 69 year old male, admitted urgently with severe crushing chest pain. His past medical history included chronic colitis. ECG confirmed ST elevation myocardial infarction (heart attack). He underwent emergent coronary angiogram through the right radial artery (in the wrist) using a 6F catheter. The test showed the left anterior descending artery - one of the arteries of the heart - was found to be occluded proximally. Using aspiration (sucking out), a small red clot and large amounts of white clot were removed. Significant stenosis was crossed and predilated with the RX Euphora 3.0mm x 20mm balloon. Following, the XIENCE PRO 3.0 x 48mm stent was deployed.

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.