[91067]
Limited left heart catheterization was performed from the right femoral artery utilizing 8f left 3. 5 xb guiding catheter, 0. 014" x 300cm stabilizer wire and 2. 5mm predator balloon. An intermediate o. O14" wire and a 2. 5 predator balloon and advanced to the lad and several attempts were made to cross the lesion. This was unsuccessful and a standard wire was also tired without success. Co then procedded to dilate the ostium of the second diagonal using several inflations, maximum up to 9 atmospheres for 45 seconds. With each inflation, the pt had angina, but no signicant st elevations. An adequate result appeared to be obtained and the pt was prepared to transferred to the ccu for further management. Before leaving the cath table, he developed recurrent angina and had repeated coronary angiography and this showed that there was recoil slightly sluggish flow down the diagonal branch. Hcp then advanced a 0. 014" x 300cm extra support stabilizer wire and using a 3. 0mm titan balloon, one inflation was performed up to 6 atmospheres for 45+ seconds. This gave an excellent channel and hcp then proceeded to insert a 3. 0 x 15mm j&j stent. The advancement to the diagonal was easy and straight forward, however deployment took place in the diagonal and the proximal half in the lad. However, it was noted that on deflating the balloon, the balloons simultaneouly came back to the mid lad. The balloon was again advanced into the stent and another inflation was performed, 4 and 6 atmospheres. The stent balloon was taken out and a 3. 0mm titan 18 balloon was then advanced with the idea of performing high pressure inflation. The balloon, however, would not cross into the diagonal branch and a brief inflation in the proximal half of the stent was performed. It was then noted that the wire was stuck in the stent and would not move. Great care was taken while exchanging the stent balloon for the titan 18 balloon and the wire remained in the distal d. With some force, however, the wire together with the stent were removed en-block. The pt remianed stable and repeat angiography revealed that the second diagonal was still widely patent with excellent flow. The distal lad remianed occluded. The directions for use, which accompany each device, recommend to the user that a stent not be utilized for ostial lesions or lesions located at a bifurcation. At the time of this report, the product upon which this medwatch is based has not been returned for evaluation. Should the product become available, a follow-up 3500a report will be submitted accordingly.
Patient Sequence No: 1, Text Type: D, B5