Call for CASES

1
Call for CASES
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

2
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, B-blocker, 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
3
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.
4
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.

5
PCI procedure

• Renal stent (NEFRO, Balton) implantation into the
  previously implanted Taxus stent
• Size 5,0x8mm
• Inflation pressure 16 atm

6
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.

7
Seven months f-up

• Seven months later the patient was controlled
  with coronary angiography
• There was no restenosis in LM.
• CCS class I

8
Similarity of ostial LM and renal artery disease

1. Similarities in vessel wall structures
2. Fibrotic/calcified lesions
3. Large vessels (gt5mm)
4. Elastic recoil
5. 40-50 coincident rate
6. The same type of disease?
7. PTA/PCI large stents with high radial
   forces/support, delivered under high pressure

9
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