Challenging Angioplasty on Patient with Heavy Smoker, Dyslipedemic and Hypertensive 2 Vessel Disease

Ahmed Abdelsalam^*
*Correspondence: Ahmed Abdelsalam, Department of Cardiology, Helios Hospitals, Germany, Tel: +493068323885, Email:

Clinical Image

A 50 years old man was presented with a non-ST-Elevation Myocardial Infarction (NSTEMI) and left ventricular ejection fraction LV EF of 61%. Physical examination revealed that the patient was heavy smoker, dyslipedemic, with hypertensive 2 vessel disease. Hypertensive heart disease is caused due to high blood pressure. Stage 2 Hypertension is characterized by a systolic blood pressure greater than 140mmHg or a diastolic blood pressure of equal to 90mmHg or higher. Epidemiological studies indicate that hypertension may result in increased risk of coronary artery disease. The chronic blood pressure elevation may result in constellation of changes in left ventricular, left atrium and coronary arteries inducing structural and functional damage. Generally relevant test are done such as echocardiography, blood pressure, and cardiac enzymes.

Cardiac catheterization

During this procedure a small flexible tube called as catheter is inserted into an artery and guided to the coronary arteries. At this point, a contrasting dye is injected through the tube that enables to detect the flow inside those arteries. This also allows locating the blockages in the coronary arteries and measuring the extent of blockage. The performing cardiologist can open any clogged arteries and this process is called as angioplasty. This may also involve placing and expanding a small tube also called as stent inside the clogged blood vessel to keep the artery open. Coronary angiograms are obtained that show total occlusions with thrombus.

Interventional management

General interventional management involves treating the lesion of acute myocardial infarction. This is followed by catheterization, antegrade ballooning and stenting. A Sion Blue wire (ASAHI INTECC CO. Ltd., Aichi, Japan) was advanced within the micro-catheter. Kinking and spasm were a challenge. Then Femoral Access obtained, AL 0.75 to support the material in such curvy RCA Sion Blue wire, Xience Pro 3.5 × 18.