Coronary Angiogram and Our Patient's Discharge
Coronary angiogram
The coronary angiogram in this patient revealed a 95% stenosis in the left anterior descending coronary artery prior to the take-off of the first septal perforator; a 95% stenosis at the origin of the diagonal branch of the left anterior descending was also identified. No thrombus was seen. Revascularization by percutaneous coronary intervention, or PCI, was recommended for both of these lesions.
That patient - post angioplasty
This is a still-frame of that patient's angiogram done after revascularization. It demonstrates lumen enlargement and good distal flow in both the left anterior descending and its diagonal branch. The real-time study follows.
PCI
Percutaneous coronary intervention is commonly used for myocardial revascularization. Acute complications are relatively infrequent, and include abrupt vessel closure and dissection that may lead to myocardial infarction.
The major limiting factor is restenosis. The use of stents to hold the vessel open reduces the incidence of restenosis in comparison to angioplasty alone. Drug-eluting stents offer decreased restenosis rates in comparison to bare metal stents. The addition of a potent inhibitor of platelet aggregation, such as clopidogrel, also reduces the likelihood of in-stent thrombosis.
Discharge
Our patient's hospital course was uncomplicated. At the time of discharge, he was instructed to continue his aspirin, beta blocker, nitroglycerin, ACE-inhibitor, warfarin and statin. He was advised to continue his health maintenance program and return for close follow-up evaluation.
Interval evaluation
When seen for a one-month follow-up visit, he was doing very well, had resumed his exercise program and was symptom free.