LEFT MAIN CORONARY ARTRY STENTING IN PATIENTS WITH CHRONIC KIDNEY DISEASE - A LIFESAVING PROCEDURE

Abstract

Background: Chronic kidney disease (CKD) is one of the most important factors for adverse outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention. These patients have poorer outcomes in comparison with patients without CKD. The strategy for the best revascularization technic in patients with CKD and coronary artery disease is still unknown because these patients are usually excluded from most clinical trials, especially in patients with moderate or severe CKD. Aim: This case report aims to show that percutaneous coronary intervention is a necessary and life-saving procedure in a critically ill patient with CKD despite the risk of complications and worsening renal function. Case Report: We present a 76 years patient with a medical history of CKD stage 4, Diabetes Mellitus type 2 on insulin therapy, and hypertension, one year ago she got a drug-eluted stent on the left anterior descendent (LAD) coronary artery, after which she has developed contrast-induced nephropathy and she underwent on hemodialysis after which kidney function stabilized. She was diagnosed with heart failure with reduced EF (23%). This patient came to the emergency department with pulmonary edema and subacute myocardial infarction. She was medically stabilized and underwent delayed percutaneous coronary intervention (PCI) with stenting to LM/pLAD after which deterioration of kidney function was observed (Creatinin456.8..498..701umol/L, Urea 22.6..23.4..27mmol/L). She underwent hemodialysis after which previously kidney function was obtained and she was dismissed in good health. Conclusion: PCI and Left main stenting is a lifesaving procedure in patients with CKD. A multidisciplinary approach and an experienced invasive cardiologist are of crucial importance for a good outcome in these patients.