IVUS Guided Primary PCI for Acute Inferior ST Elevation MI of Occluded RCA done by Corindus GRX Vascular Robotic System

45-year-old male with known case of ACS,CCS class II, DM II, HTN, DLP presented with typical chest pain and was admitted as a case of infero-poterolateral STEMI. Patient was referred for primary PCI.

ECG - ST Elevation II,III, aVF, I, aVL

ECHO - RSWMA, inferior wall Hypokinesia, EF45%

LAB

Creatinine - 77.7 μmol/L

eGFR - 104mL/min/1.73m²

Coronary Angiography

Angiography showed that the left main coronary artery is normal, without any stenosis. The mid left anterior descending coronary artery has a non-flow-limiting (less than 30%) stenosis.

The first diagonal coronary artery has a critical (90-99%) stenosis. The first obtuse marginal coronary artery has a non-flow-limiting (less than 30%) stenosis. Right dominance. Acute occlusion of the mid right coronary artery.

Procedure

Angiography was preformed through the right radial artery using a 6F sheath and a JR4 6F catheter. Angiogram showed non significant lesion in the left coronary artery. The right coronary artery showed thrombotic acute occlusion of the mid RCA.

Successful IVUS guided primary PCI was done for thrombolysed inferoposterolateral MI patient to mid RCA using Corindus Robotic Vascular System.

Procedure was done in 60 minutes and 22 minutes total floroscopic time, using 200ml contrast amount (Visipaque type), and 8264 μGym² radiation dose.

Angioplasty

After administration of IV Heparin (as PCI protocol), a work horse wire was used to cross the occlusion using the Corindus Vascular system.

Wire features were used (ROR, Wiggle) to help wire negotiations to cross distally. After successful wire crossing distally, 3x20mm predilation balloon was used to dilate the lesion. It was followed by intravascular images (IVUS, Eagle Eye, Volcano) used for better evaluation of the lesion and vessel sizing, then DES (3.5mmx16mm) was deployed successfully at the site of occlusion, that was followed by NC balloon inflation (2.25mmx12mm) for post stent optimization. Then, another IVUS run was done showing well deployed stent, good result with successful recanalization of mid right coronary artery using 1 drug-eluting stent, without evidence of inlet or outlet dissections, TIMI3 flow can be seen in the RCA.

All angioplasty steps (wire crossing, balloon predilatation, IVUS imaging, stent deployment) are performed by the Corindus GRX Robotic Vascular System.

Conclusion

PCI with Corindus Robotic Vascular System is feasible and safe in cases with acute myocardial infarction with thrombus containing lesion.