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Montreal Heart Institute

5000 Rue Bélanger, Montreal,
Quebec H1T 1C8

Impella-Assisted PCI Of LAD And LCx Guided By OCT

Complex Multivessel

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CLINICAL SCENARIO: Presented to OSH w/ altered mental state and multi-organ failure. Elevated hs-Tn I

Dx: NSTEMI type I vs II

RISK FACTORS: HTN, DLP, active smoker

MEDICAL HISTORY: Hepatitis B, Hx of Amphetamine & Cocaine use, Alcohol abuse

CLINICAL EVOLUTION The patient was admitted with multi-organ failure (cardiogenic shock, acute renal + hepatic failure, delirium) due to acetaminophen intoxication. Due to a predominantly cardiogenic shock phenotype, TTE was performed: LVEF 20-25% with diffuse HK. Once stabilized, LV dysfunction prompted referral for diagnostic catheterization at his OSH Cath Lab.

Interventional Plan: Aim for complete revascularization. Adjust the plan according to IC Imaging (MLD-MAX OCT-based). Use of LV support: ULM-PCI. Use of LV support: Calcium modification. Start with RCA first (help for stability when going for ULM-PCI). Address LCx and LAD disease subsequently. Finish with ULM-PCI: Provisional > 2-stent strategy


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