Case 169: Manual of PCI - The 3.5 mm stent

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Case 169: Manual of PCI - The 3.5 mm stent

Рет қаралды 3,325

3 ай бұрын

A patient presented with NSTEMI and was found to have severe disease in the RCA by coronary CT angiography. The estimated stent length was 47 mm and the distal and proximal reference diameters were 3.3 and 3.7 mm, respectively. There was scattered calcification. The lesion was predilated and stented with a 3.0x38 mm DES, but the distal edge was not completely covered. A 2nd DES, 3.5x12 mm was deployed distally overlapping the initial stent but the result appeared suboptimal. IVUS showed that the 2nd size was much smaller than the first one. Re-inspection of the packing showed that the 2nd stent was 2.5x12 mm. The 2nd stent was postdilated with a 3.5 mm NC balloon with an excellent final result.

Пікірлер: 17

@nanoevolution1 3 ай бұрын

Situations like this happen in every cath lab, it’s a very important point! Thank you 🙏🏼

@elmiraaghaee6550 3 ай бұрын

Wonderful case that remind us angioplasty is a team work 👏 ❤

@shangz0216 3 ай бұрын

Thank for the educative case presentation.

@tom11298 3 ай бұрын

CT is a really great tool, making pre-ivus assessment sometime not needed (especially in non-LM), areas. Well done! Another CT fact: not every extensive calcium on CT is really stenotic, if the patient is a long term user of statins, the calcium is more likely to be superficial/not growing into the lumen.

@doctorcardio3886 2 ай бұрын

Why did you place 3 mm stent proximally and ask for 3.5 mm stent distally? also,did you post dilate proximal stent to 3.5 mm?

@mostabdrabou 3 ай бұрын

Thank you sir a very nice case What software do you use for analysis of ct data ? And is this photon count ct ?

@drsidiyengar 3 ай бұрын

About extra dye load on using CT

@manosbrilakis 3 ай бұрын

Good point - we do not do CCTA in patients with low GFR. If we absolutely need a coronary CT, we will stage the PCI for several days/weeks later.

@Shadeslayer200593 3 ай бұрын

Distal perforation at 2:50?

@manosbrilakis 3 ай бұрын

Good observation - this is actually contrast in the venous phase going into the coronary sinus.

@johnwilson7660 3 ай бұрын

I wonder if post dilating that distal stent to what I would assume was its max internal diameter will affect the rate of drug elution. Some of the older generations of stents would elute the drug faster if you overexpanded them beyond their maximum rating because the coating would crack and have more surface area exposed.

@manosbrilakis 3 ай бұрын

Agree with you but the alternative would be to implant another DES which I did not feel comfortable doing.

@johnwilson7660 3 ай бұрын

@@manosbrilakis I recently learned that boston has a coronary dcb out with an indication for in stent restenosis. I wonder if you would get a longer lasting effect from post dilating with that after the nc. Might be as/more expensive than another stent, but you wouldn't have two layers of stents.