A
77-year-old man with history of ischemic cardiomyopathy with left ventricular
ejection fraction 20-25% and atrial fibrillation was transferred to our
hospital post cardiac arrest.He was noted
to have positive troponins and was diagnosed with NSTEMI. He was treated with
aspirin 81mg, a loading dose of plavix of 600 mg with subsequent maintenance
dose of 75 mg and intravenous heparin infusion. After stabilization, cardiac
catheterization was performed via a right femoral approach, due to limited
radial arterial access, revealing multi-vessel coronary artery disease with a
syntax score of 16.
Hemostasis post-procedure was achieved with a StarClose SE
device with no post deployment oozing or delayed hemostasis. He was felt to be
at extreme surgical risk and was referred for highrisk percutaneous coronary
intervention (PCI). Again, right femoral arterial access was obtained and a 6F
sheath was introduced. PCI was performed with the placement of fourdrug-eluting stents: one in the proximal LAD, a second in the ramus
intermedius, and two in the first obtuse marginal. Prior to PCI, retrograde
sheath angiography was performed to evaluate the access site for hemostasis and
suitability for closure.
The femoral
arterial canulation site was noted to be approximately 2 cm cranial to the
prior access site closed with the Star Close device (Figure 1A). Retrograde
sheath angiography revealed the previously deployed Star Close clip with a 0.5
cm pseudo-aneurysm emanating from its center. As the
pseudo-aneurysm was small, the decision was made to achieve hemostasis and to
treat the pseudo-aneurysm simultaneously by applying manual pressure for
hemostasis. There was no post-compression bleeding, oozing or other
post procedure complications.Read more.....
No comments:
Post a Comment