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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