90 year old gentleman, resident of choolaimediu, manager by occupation for past 30 years post his retirement from Indian Railways, walked into our OPD with complaints of chest discomfort on minimal exertion. We assessed his daily routine and found that he is riding a bicycle, going to the office everyday and leading an absolutely normal life.
We evaluated him thoroughly and decided that he should be given an option of coronary angiogram following ECG changes and on going chest discomfort. He is a known case of hypertension and diabetes mellitus for more than 10 years on regular treatment and follow up. His coronary angiogram revealed single vessel disease (LAD) has 95% long with moderate calcium lesion in the midsegment on 16.11.2017. He withstood the procedure well.
Taking up a nanogerian for a PTCA was challenging our own skills and also setting up new boundaries for cardiac intervention with regards to PTC. The need for dual antiplatelets in the post PTCA period, side effects of its use was explained to the patient in detail. He was taken up for PTCA 21.11.2017 after informed consent. We used the most advanced intravascular ultrasound technique (IVUS) to define the lesion and approximate the size of the stent taking into account fragile delicate vessels of 90 year old. So the Intravascular ultrasound technique (IVUS) was used.
Right radial approach was taken. Left coronary artery was engaged with 6 Fr EBU 3.5 Medtronic guiding catheter. The LAD lesion was crossed with 0.014″ BMW guide wire. IVUS was done using OPTICROSS 3.0 F (1.00 mm) x 135 cm. Predilated the lesion by using 2.00 x 5mm MOZEC balloon and 2.5 x 15mm MAVERICK balloon. A 2.5 x 48mm XIENCE XPEDITION stent was positioned and deployed at 14 ATM (30 sec). Then stent deployment was optimised by post dilatation with IVUS guidance. Procedure was uneventful and patient was shifted to ICCU with stable hemodynamics. He was discharged on 23.11.2017 with appropriate drugs.
The patient was ecstatic about him becoming an young man at heart with successful PTCA to LAD. He plans to continue his managerial job in the forthcoming years. He profusely thanked the team of doctors headed by Dr. SANJIV AGRAWAL. and the paramedical staff at Fortis Malar Hospital who helped him recover quickly from a medical ailment like coronary artery disease. It was an absolute pleasure treating a nanogerian with very high spirits and zest to live life to the fullest.
Dr. Sanjiv Agrawal is the senior most interventional cardiologist in Fortis Malar Hospital for the past 30 years. He has vast experience in treating complex, multivessel coronary artery disease patients both as elective and primary percutaneous interventions.
