097H Chest pain LAD disease CTA Stress Cath positive

C
EMR: 52-year-old male with multiple cardiac risk factors presenting
with  chest pain – angina or anginal equivalent, with pain induced by exercise and relieved by rest.

Troponins negative.

Inducible chest pain with exercise stress test.  Chest pain while on treadmill 10 minutes

CTA

The dominant finding is a calcified plaque in the proximal LAD with a
suggestion of a 50-70% stenosis at the level of this plaque. There is
also a plaque in the mid circumflex, with an approximate stenosis of
50%
Focal calcified atherosclerotic plaque within the proximal RCA with
minimal stenosis.

Agatston calcium score of 254.12, 91st percentile for patient’s
cohort and indicative of moderate coronary artery disease.

Left ventricular hypertrophy with a LV mass of 186.2 g and LV wall
thickness of 14 mm in diastole with normal ejection fraction of 56%.

RECOMMENDATION:

CAD RADS 3: Consider further functional testing


LAD

LCX

RCA

Stress PET

Abnormal pharmacologic PET nuclear stress test. There is a small area of ischemia in the basal to mid inferolateral wall. Overall left
ventricular systolic function is normal, but with inferolateral hypokinesis during stress.

Atherosclerotic calcifications in the aorta and coronary arteries
noted on CT imaging.

Abnormal pharmacologic PET nuclear stress test. There is a small area of ischemia in the basal to mid inferolateral wall. Overall left
ventricular systolic function is normal, but with inferolateral hypokinesis during stress.

Cardiac Cath

Left Anterior Descending: serial 70% and 80% mid stenosis
LCX:
Left Circ: 99% mid stenosis with 60% distal stenosis
RCA:
RCA: Normal

Balloon Angioplasty – Coronary
Stent – Coronary

CONCLUSIONS:
Successful revascularization of mid and distal LCx stenosis

LESION #1 INTERVENTION: Mid-LAD artery segment – mLAD
Guide wire advanced –  Abbott Asahi Prowater (180cm) Wire
Guide catheter advanced –  Cordis 6 Fr XB 3
Balloon catheter advanced and inflated –  Abbott Trek RX Balloon 2.5
x 15mm
Drug Eluting Stent advanced and deployed –  Abbott Drug Eluting
Stent 2.5 x 23mm
Balloon catheter advanced and inflated –  Abbott NC Trek RX Balloon
3.0 x 15mm

 

 

 

 

 

Stress PET

Abnormal pharmacologic PET nuclear stress test. There is a small area
of
ischemia in the basal to mid inferolateral wall. Overall left
ventricular
systolic function is normal, but with inferolateral hypokinesis during
stress.

Atherosclerotic calcifications in the aorta and coronary arteries
noted on
CT imaging.