Live Case of a Patient with Diabetes Mellitus
This was a case of multivessel disease in a patient with DM. The patient had a prior history of atrial fibrillation (AF) and was taking oral anticoagulants. He was also suffering from hypertension, hyperlipidaemia and angina. An electrocardiogram (ECG) showed AF with ventricular response. Blood tests showed high glucose and glycated haemoglobin (HbA1c) levels and slightly abnormal cholesterol levels. The patient presented with angina (Canadian Cardiovascular Society [CCS] class 2). Angiography showed calcified stenosis of the proximal left anterior descending (LAD) artery and a double bifurcation stenosis of the marginal artery.
The primary aim of the intervention was to treat the long lesion of the LAD. The lesion was wired using regular wire then dilated using a 2.0 balloon. A long stent was used (Cre8™ 46 mm), which crossed the lesion easily. There were two bifurcation lesions: one proximal LCX and one distal. The marginal branch lesion was dilated with a 2.5 balloon and a single stent was used with good result. The aim was to put a stent on the main branch and the use of two stents was considered an alternative possible solution. A 2.5 mm x 20 mm Cre8™ stent was used for the proximal lesion; a 2.75 mm x 8 mm stent was used for the distal lesion. The artery was successfully opened. A 3.25 mm stent was used for the distal circumflex lesion. A radial approach was selected because the patient was in AF taking oral anticoagulation.
The use of the Cre8™ stent should allow cessation of DAPT at 3 months and to continue with a single antiplatelet agent as well as oral anticoagulation. Closure of the left atrial appendage (LAA) was discussed as an option if an issue arises with triple therapy.
The publication of this article was supported by Alvimedica.