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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.