HEAPHY 1 & 2

CASE RACE 1 – DIAG

Rowena OLIVER

Sat 31st Aug 2013

Session 3 / CR1-6

13:26 – 13:30

OTAGO / SOUTHLAND

ABSTRACTA case of a 81 year old female previous history of Coronary artery disease with CABG. presenting with chest pain and troponins raise.  Send to Cath Lab for coronary and grafts angiography to determine cause of chest pain. What could go wrong with a routine procedure?

THINGS ALWAYS GET WORSE BEFORE THEY

GET BETTER

ROWENA OLIVER NDIMDI

STAFF MRTDUNEDIN RADIOLOGYDUNEDIN HOSPITAL

PATIENT HISTORY

81year old female Previous history of:

unstable angina 10 years post Coronary Artery Bypass Graft

surgery (C.A.B.G) - 3 vessel grafts

Presented with prolonged chest pain.Transferred from: Southland Hospital to Dunedin Hospital. Referral for Cardiac Angiography

PATIENT PREPARATIONInformed consent was given.

- Procedure benefits of Cardiac Angiography- Diagnosis- Stents

- Alternatives and risk including but not limited to:

- Heart attack - Death- Stoke- Lost of limb- Vessel injury- Contrast reaction- Bleeding- Infection- Open heart surgery- Renal failure

Left Internal Mammary Artery (LIMA)Graft to Left Anterior Descending Artery

(LAD)Left Internal Mammary Artery (LIMA)Left Anterior Descending Artery (LAD)

Catheter Kink in Origin of Left Radial Artery

to Brachial Artery

CATHETER KINK

Right Femoral Artery Approach to Left Subclavian Artery

LIMA CATHETER

Guiding Catheter

Right Femoral Artery approach to Left

Subclavian Artery with Goose Neck Snaring of LIMA Catheter

VERTEBRAL ARTERY

CAROTID SHEATH

LIMA CATHETERSNARE

LIMA Catheter Snared and Removal

CAROTID SHEATH

LIMA CATHETER SNARED

martyink.com 23/07/2013

Antegrade and Retrograde Imaging

VERTEBRAL ARTERYDISSECTION FLAP

OCCLUSION

Ballooning & Positioning of Stent in

Subclavian Artery8mm x 4cm BALLOON 8mm x 4cm STENT

Deployment of Stent

Partly Deploy Stent

Post Stent DeploymentVERTEBRAL ARTERY

LIMA

50% Stenosis

onwardstate.com 27/07/2013

Perforation and Extravasation

Post Previous

PerforationExtravasated Contrast

Post Covered Stentsof Radial-Brachial Arteries

gefaesszentrum-bochum.com- 26/07/2013

COVERED STENT

ACKNOWLEDGEMENTSThe Anonymous Professor of Cardiology

&Cardiology, Radiology Team

Dunedin Hospital