Interventional Challenging Cases
Wednesday, Dec. 2 at 1 p.m. ET
The ACC is now accepting Interventional Challenging Case submissions. Submit your Interventional Challenging Case for a chance to be featured at ACC.21, where you'll share your case with colleagues from around the world.
Selected case presenters will have 10 minutes to present followed by 5 minutes of discussion and debate with the moderator, panel of experts and your peers. Cases must be submitted in PowerPoint format. Be sure to include a brief history including non-invasive testing, angiogram information and interventional details. Please note: cases submitted to a category that does not match the subject matter may be given a low score by the reviewers.
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Sample Interventional Challenging Case
Recurrent Spontaneous Coronary Artery Dissection in a Patient With Fibromuscular Dysplasia
Patient Initials or Identifier Number: KW
Relevant History and Physical Exam: A 39 year old African American woman with no significant past medical history presented with sudden onset chest pain, nausea and diaphoreses while driving to work. Her physical examination was unremarkable.
Relevant Test Results Prior to Catheterization: The patient's electrocardiogram revealed anterior ST elevations (V1-4). Bedside echocardiogram revealed an ejection fraction of 50%, with mild apical hypokinesis.
Relevant Catheterization Findings: Emergent cardiac catheterization revealed normal RCA and LCx, with a diffuse 75% mid-distal LAD narrowing. IVUS confirmed a dissection in the segment corresponding to the area of angiographic narrowing.
Interventional Management: A sirolimus eluting stents (Cypher RX), 2.5 x 28mm and 2.5 x 18mm were deployed in the distal LAD and the mid LAD respectively. Following second stent deployment dissection propagated proximally requiring additional Cypher RX 3.0 x 13mm stent placement to contain the dissection. IVUS was then used to ensure containment of the dissection and adequate stent strut apposition. The patient was discharged 2 days post-procedure on dual antiplatelet therapy in stable condition. The patient discontinued both aspirin and clopidogrel in spite of medical advice 3 years after initial presentation. Eight years after presentation she developed recurrent chest pain and ruled in for NSTEMI. Cardiac angiogram revealed a dissection in the distal, small sized LCX segment not amenable to interventional treatment. Patient received aspirin and clopidogrel as well as guideline directed medical therapy (GDMT). While on antiplatelet and GDMT an angiography 1 year after LCx dissection revealed a healed dissection and patent stents in the LAD. Magnetic resonance angiography (MRA) revealed a 'beaded' appearing right renal artery, most consistent with "multifocal" form of fibromuscular dysplasia (FMD).
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