Case Report: A success story of IVUS: In a PTCA

Vishnu C

Deputy Nursing Superintendent, Kauvery Hospital, Hosur

Correspondence: M – 9087030738; Email – nursing.hosur@kauveryhospital.com

Background

Intravascular Ultrasound (IVUS) or Intravascular Echocardiography is a medical imaging technology using a specially designed catheter with a miniaturized ultrasound probe attached to the distal end of the catheter. The proximal end of the catheter is attached to computerized ultrasound equipment. It allows the application of ultrasound technology, such as piezoelectric transducer or CMUT, to see from inside blood vessels, through the surrounding blood stream, visualizing the endothelium (inner wall) of blood vessels.

The arteries of the heart (the coronary arteries) are the most frequent imaging target for IVUS. IVUS is used in the coronary arteries to determine the amount of atheromatous plaque built up at any particular point in the epicardial coronary artery. Intravascular ultrasound provides a unique method to study the regression or progression of atherosclerotic lesions in vivo. The progressive accumulation of plaque within the artery wall over decades is the setup for vulnerable plaque which, in turn, leads to heart attack and stenosis (narrowing) of the artery (known as coronary artery lesions). IVUS is used to determine both plaque volume within the wall of the artery and/or the degree of stenosis of the artery lumen. It can be especially useful in situations in which angiographic imaging is considered unreliable; such as for the lumen of ostia lesions or where angiographic images do not visualize lumen segments adequately at the time of balloon angioplasty, with or without stents, and to evaluate the results of medical therapy over time.

Case presentation

A 49 years old male, came with the complaints of chest pain in OPD. He was diagnosed with IWMI previously. After the evaluation by the Consultant, plan was to do PTCA to LAD, so patient was admitted and shifted to ward for further.

Examination

On examination patient was conscious and oriented.

CVS	S1 S2 +
RS	BAE +
P/A	Soft, BS +
CNS	NFND
SAO2	96%
BP	120/80 mm Hg
HR	56 b/m
RR	20 b/m
Temp	97o F

Past Surgical History

A 49 years old male, known Type II DM and Dyslipidemia on treatment,

CAD- Evolved IWMI / Severe LV dysfunction

CAG – TVD on 27.11.2023.

S/P – Adhoc PTCA + Stenting LCX using 3×24mm PROMUS ELITE stent and on regular medications.

Now admitted for PTCA + stenting – LAD. No angina / dyspnea.

Evolution

Patient was admitted to ward as per Consultant’s order. Patient was conscious and oriented.
Blood samples were taken and sent to the Lab (RFF, Na, K+)
The patient’s OT preparation was done, IV medication given and started two IV line, NPO at 2 hr.
As per consultant order, Echo was done and patient shifted to Cath Lab for procedure.
Procedure: IVUS guided PTCA and Stenting of Proximal mid LAD with Rotablation using 1.5 mm Rota burr and by using 2.5 × 38 mm Promus elite stent and 3 × 32 mm Promus elite stent with optimal results done on Cath lab at 16.12.2023.
Right Femoral approach was employed. Sheath present and position done, Pressure bandage was applied. There was no hematoma and Bleeding occurred.
Patient was stable throughout the procedure and shifted to ICU in stable hemodynamics.

Post Procedure Care

POD: 1

Patient shifted to ICU care, Vitals are stable, Sheath removal not done.
The Consultant advised to take ECG, sheath removal was done after 2 hr of procedure. IV line and IV fluids was started.
After the sheath removal was done, mild hematoma was present but no increase.
Oral food taken by the patient, no vomiting; medications were given.
The Consultant advised to shift the patient to ward and plan to do (RFT, Na+, K+) and Fluid restriction at 1.5 to 1.75 liters/day.

Ward Care

The patient was shifted to ward, there was no complaints and stable and oriented, self-voiding.
Medications given as per consultant order and Echo screening was done, there was no complaints.
Patient discharged with IV cannula and discharge medication explained.

Condition at Discharge

General condition – Patient conscious, oriented.

Vital Signs – PR: 76 bpm, BP: 120/70 mm Hg

CVS – S1 S2

RS – NVBS

P/A – Soft

CNS – Within normal limits

Advice on Discharge

Diet – 1500 Kcal low-fat, low-cholesterol, salt restricted and diabetic diet.

Discharge medications

Drugs	Dose	Frequency
Tab. Ecosprin	75 mg	1-0-0 × to continue (Do not stop)
Tab. Brilinta	90 mg	1-0-1 × to continue (Do not stop)
Tab. Aztor	80 mg	0-0-1×continue
Tab. Carvidon MT	25 mg	1-0-0 × to continue
Tab. Fruselac	20/50 mg	1/2-0-0 × to continue
Tab. K Cor	5 mg	1-0-1 × to continue
Tab. Pantocid	80 mg	1-0-0 × to continue
Tab. Zolfresh	5 mg	0-0-1 ×2 weeks
Tab. Sitared D	5/50 mg	1-0-1 × to continue
Tab. Glimestar M2	2 mg	1-0-1 × to continue
Inj. H. Mixtard		22 units-0-18 units ×to continue

Conclusion

In our Cathlab, we have done 80–90 cases average per month. In 2023, we had done totally 1059 cases. We had cases like CAG, PTCA, MI cases etc., but this IVUS (Intravascular Ultrasound) with PTCA procedure was first time successfully done in our unit with great success. The main thing, still there was no Hematoma formed when patient got discharge and no complaints received at the period of review time also. The patient was very happy with our treatment.

Vishnu
Deputy Nursing Superintendent