this morning, I was permitted to have a sandwich before 8:00 am, as my blood glucose reading was stable at 4.8, eliminating the need for insulin injections or diabetes medication... I was then required to fast in preparation for the angioplasty procedure scheduled for 1:00 pm... at 9:30 am, Dr. Liew visited to explain the procedure in detail, informing me that I would be placed under sedation so he could maintain full focus, particularly since my hands had moved involuntarily during a previous procedure while I was conscious... as 2 stents are to be inserted today, precision is crucial... Naja will be arriving from the office before the procedure begins...
my HbA1c result of 8.9% (73.76 mmol/mol) indicates that my blood glucose has been poorly controlled and remains within the diabetes range, suggesting that blood sugar levels have been consistently elevated over the past few months... however, this result represents a significant improvement compared to my previous readings, reflecting positive progress in managing my condition... while the level is still above the recommended target, the improvement indicates that ongoing efforts in treatment, lifestyle changes, and glucose monitoring are having a beneficial effect and should be continued to achieve better long‑term control...
the coronary angiography procedure was performed with the support of a multidisciplinary catheterization laboratory team, comprising Co Treating Doctor: Dr. Amiruddin, Technologist: Loshini, Scrub Nurse: Asuani, Circulating Nurses: Kokila and Nur Farhah Asyiqin, and Radiographer: Syarul Hafiz, using Optitorque 5F catheters for both the left and right coronary systems... angiographic findings demonstrated a normal left main stem, but revealed critical obstructive disease involving the proximal left anterior descending artery (90%), a small first diagonal branch with severe stenosis (90%), and a significantly diseased obtuse marginal branch (OM1) with 90% stenosis, while the circumflex artery itself was recessive and otherwise normal... the right coronary artery showed a patent proximal stent with normal mid-to-distal segments, although moderate disease (50%) was noted in the PDA and PLV branches... overall, the findings confirm patent prior intervention to the RCA with significant residual coronary artery disease in the proximal LAD and OM1, for which percutaneous coronary intervention (PCI) to the proximal LAD and OM1 is recommended...
the procedure performed was a staged percutaneous coronary intervention (PCI) aimed at restoring adequate blood flow to two critically narrowed coronary arteries: the proximal left anterior descending artery (LAD) and the first obtuse marginal branch (OM1)... access was obtained through the right radial artery, a commonly preferred approach due to its lower bleeding risk and faster post‑procedure recovery... once vascular access was secured, intra‑arterial heparin (7,000 units) was administered to prevent clot formation, and glyceryl trinitrate (100 µg) was given to minimize arterial spasm and improve vessel visualization...
An EBU 3.5 French guide catheter was used to engage the left main coronary artery (LMCA), providing stable support for the intervention... a Runthrough NS coronary guidewire was then advanced across the diseased segments to serve as a rail for device delivery...
for the proximal LAD, the guidewire was positioned distally, and a direct stenting strategy was employed, meaning the stent was deployed without prior balloon predilatation... a SYNERGY drug‑eluting stent (2.5 × 28 mm) was placed across the lesion and expanded up to 16 atmospheres, adequately covering the diseased segment... to ensure optimal stent expansion and apposition against the vessel wall, post‑dilatation was performed using a PANTERA LEO non‑compliant balloon (2.75 × 15 mm) inflated to 20 atmospheres, achieving an effective vessel diameter of approximately 2.83 mm...
attention was then directed to the OM1 branch, where a similar technique was applied... the vessel was wired with a Runthrough guidewire, followed by direct stenting using a BioFreedom drug‑coated stent (2.5 mm diameter) deployed at 12 atmospheres... further optimization was achieved with post‑dilatation using a PANTERA LEO 2.75 × 15 mm balloon inflated to 18 atmospheres, resulting in a final diameter of approximately 2.80 mm...
final angiographic assessment demonstrated excellent results, with good stent expansion, restored coronary blood flow, and no complications such as dissection or vessel perforation... the right radial sheath was subsequently removed, and haemostasis was achieved using a TR Band, concluding a successful and uncomplicated PCI procedure...
the procedure lasted approximately 1 hour and 30 minutes... during the time I was under sedation, I experienced something deeply personal and difficult to explain - I saw my late mother’s face clearly before me... she urged me to recite Surah Al-Fatihah continuously, and before she faded from view, she reminded me never to abandon my prayers... when my name was called, her face disappeared and I regained consciousness... later, the doctor’s assistant who had been nearby told me that my lips had been continuously reciting Surah Al-Fatihah from the moment I was sedated until I woke up... ya Allah, I am profoundly grateful for being granted the chance to be with my late mother again, even if only for a fleeting moment...
I was placed in the Intensive Care Unit for close monitoring following the procedure, and special permission was granted for Naja, Azim, and Abyana to visit me earlier than usual... as I shared with Naja my experience of seeing my late mother, tears flowed uncontrollably, revealing the depth of my longing and love for her... in that moment, the ICU felt less clinical and more human, filled with emotion, gratitude, and an overwhelming sense of yearning for a mother who remains forever close to my heart...
visiting hours in the ICU are strictly regulated, allowing only brief periods of time with loved ones... my family left at 6:00 pm, and shortly afterward, my dinner was delivered to the unit... that evening’s meal was chicken pandan with Thai sauce, a fragrant and comforting dish that stood out despite the clinical surroundings, and I began eating at 6:30 pm, bringing a quiet sense of normalcy to the end of a long and emotionally demanding day...
Dr. Liew visited me at 7:30 pm and shared with me the arterial tree before the procedures... he carefully showed me images of my coronary arteries before and after the stent procedure... the results were reassuring, appearing smooth and well-restored, much like the outcome of my previous procedure...
later that evening, at 9:30 pm, after the dressing on my hand was removed, he approved my transfer back to the ward... at last, I returned to my room, ready to rest and recover for the night...
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