Webinar 8 | Bifurcation Badness - Cases from South Asia-Case presentation, Dr. Bashir Hanif

Video Transcription

Video Summary

In this case presentation, a 66-year-old diabetic woman with a history of renal transplant failure on hemodialysis experienced chest pain and transient ST elevations during dialysis. Angiography revealed severe calcification and disease in the left anterior descending artery (LAD) and ramus, but a relatively clear circumflex artery. The team debated interventions, including balloon angioplasty, drug-coated balloon (DCB) use, and whether atherectomy was appropriate given the heavy calcification and acute setting. They proceeded with a staged approach: wiring the LAD and ramus, pre-dilating with non-compliant balloons, deploying a stent in the mid-LAD, and applying a DCB to the ramus. They also placed a stent in the left main artery due to proximal edge dissection and finalized the procedure with kissing balloon inflation. The patient remained stable and was discharged after three days. Panelists discussed the choice of guide catheter size, the risks of atherectomy, and the off-label but feasible use of DCBs in bifurcation lesions.

Keywords

renal transplant failure

hemodialysis

left anterior descending artery

drug-coated balloon

atherectomy risks