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Call for CASES
MSCT for LMCA stenting follow-up
Krzysztof Milewski
Motaz AbuSamra
CCU, Upper-Silesian Center of Cardiology,
Silesian Medical School, Katowice, Poland
Head of Department: Pawel Buszman, MD, FESC,
FSCAI
Introduction
Routine coronary angiography is strongly
recommended after LM stenting.
MSCT- a noninvasive method to detect ISR
after LM stenting would be of evident clinical
value.
In this case we present the potential of MSCT
for detecting LM ISR
Description of the
problem
56-years old man after LM stenting (TAXUS;
Boston Scientific) admitted to ICCU to be
controlled by coronary angiography and MSCT
Medical History:
Lateral wall myocardial infarction and PTCA OM with stent
implantation (2005)
PTCA-LM with DES implantation (2006)
Risk factors: hipertonia arterialis, obesitis, familly history,
current smoker
Concomitant treatment: ASA,Ticlopidin, B-blocker, ACE, statin
ECG: Q wave in II, III, aVF and T wave inversion in I, II,aVL,
V5, V6.
LVEF assessed by echocardiography: 62%.
Baseline coronarography
Coronary angiography performed at 03.2006 showed:
significant LM stenosis
in stent restenosis (obtuse marginal)
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 18-24 atm (direct stenting).Residual stenosis 0%
POBA in OM (2.5x30mm) under the prussure of 14 atm. Residual
stenosis 0%
After PCI
wide LM without residual stenosis
No residual stenosis in obtuse marginal
No dissection
TIMI 3
Seven months f-up
LM
Seven months later the patient was controlled by
coronary angiography and MSCT
There was no restenosis in LM.
Seven months f-up
LM
LM
The MSCT shown high quality of silds with stent in LM
Summary
A 54 year old male after LM stenting was admitted to ICCU for
controll coronary angiografy and MSCT.
Seven months after LM stenting coronary angiography and MSCT
showed no stenosis in LM after DES implantation.
Current MSCT technology allows reliable noninvasive
evaluation of selected patients after LMCA stenting with
high quallity of slids of big vessels.
MSCT is safe to exclude left main ISR and may therefore
be an acceptable first-line alternative to CCA.