Call for CASES

1
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

2
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

3
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.

4
Baseline coronarography

• Coronary angiography performed at 03.2006
  showed
• significant LM stenosis
• in stent restenosis (obtuse marginal)

5
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

6
After PCI

• wide LM without residual stenosis
• No residual stenosis in obtuse marginal
• No dissection
• TIMI 3

7
Seven months f-up
LM

• Seven months later the patient was controlled by
  coronary angiography and MSCT
• There was no restenosis in LM.

8
Seven months f-up
LM
LM
The MSCT shown high quality of silds with stent
in LM
9
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.