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Stent recoil after LM stenting
Motaz AbuSamra
Krzysztof Milewski
CCU, Upper-Silesian Center of Cardiology,
Silesian Medical School, Katowice, Poland
Head of Department: Pawel Buszman, MD, FESC, FSCAI
Description of the
problem
56-years old man with unstable angina pectoris reffered to ICCU at
Upper Silesian Heart Center beacuse of LM disease and CTO of RCA.
Medical History:
Inferior Myocardial Infarction (2000).
Risk factors: hipertonia arterialis.
Concomitant treatment: ASA, isosorbide mononitrate, Bblocker, ACE, statin
ECG: Q wave in II, III, aVF and T wave inversion in III, aVF.
LVEF assessed by echocardiography: 60%.
Enzymes: Troponin: negative
CPK-MB: 9 U/L
Euroscoure : 2
Baseline coronarography
Coronary angiography showed severe LM stenosis and
RCA occlusion (Syntax score = 3 )
Consultants’ Team (Interventional cardiologist
and Cardiac Surgeons) decided to send the patient for ULMCA stenting.
PCI procedure
Administration of ticlopidine and ASA.
Routine anticoagulation during procedure.
Guiding catheter: Judkins Left 4.0 7F.
Taxus stent (4.5x12mm) implantation to the LM ostium under
the pessure of 18 atm (direct stenting).
Residual stenosis c.a. 50%- stent recoil phenomenon.
PCI procedure
Renal stent (NEFRO, Balton) implantation into the
previously implanted Taxus stent
Size: 5,0x8mm
Inflation pressure: 16 atm
After PCI
Residual stenosis: 0%.
TIMI flow: 3
No complication.
No ECG changes in comparison with baseline.
Two days after the procedure patient was discharged in
good health with no complication.
Seven months f-up
Seven months later the patient was controlled with
coronary angiography
There was no restenosis in LM.
CCS class: I
Similarity of ostial LM and
renal artery disease
I.
II.
III.
IV.
V.
VI.
VII.
Similarities in vessel wall structures
Fibrotic/calcified lesions
Large vessels (>5mm)
Elastic recoil
40-50% coincident rate
The same type of disease?
PTA/PCI: large stents with high radial
forces/support, delivered under high pressure
Summary
A 56 year old male with unstable angina was admitted to the
hospital for interventional diagnosis and treatment.
Coronary angiography showed severe LM stenosis
After TAXUS stent implantation the recoil phenomenon was
observed. It was succesfuly treatet with renal „NEFRO” stent
implantation
Patient left hospital on combined antiplatelet therapy with
aspirin and ticlopidine ordered for 6 months.
After 7 months patient was angiographically controlled and no
LM stenosis was observed
Application of renal „NEFRO” stent is feasible and efficient for
leasions locaeted in LM with high elastic force