- Email: [email protected]
PP-177 CAN LAD OCCLUSION RESTORE LIMA GRAFT FLOW?
Poster Presentations / International Journal of Cardiology 163S1 (2013) S81–S211
Case: A 65-year-old man with a history of hypertension and hyperlipydemia admitted to our center with subacute inferior myocardial infarction. Coronary angiography showed total occlusion of right coronary artery (RCA) before the right ventricular branch. After stent implantation to infarct related lesion we assessed a severe stenosis in distal RCA and decided to implant a 3.25×10 mm stent to this lesion. However the stent was stuck in the prior stent and then slipped half way off from the balloon catheter. We tried to advance the balloon inside of the slipped stent but failed. We decided to use a smaller balloon. A 1.5×20-mm balloon catheter was advanced through the guide wire and then through the the slipped-stent. We inflated the balloon to 3-atm and started to retrieve the stent-balloon complex into the guiding catheter. The slipped stent was withdrawn uneventfully and a 3.0×20 mm stent implanted to the target lesion after predilatation. Discussion: Stent dislodgement from the delivery system most often occurs when the stent balloon assembly is pulled back into the guiding catheter, or when the target lesion cannot be passed due to unfavorable anatomy. Factors predisposing to the inability of stent delivery are poor support of the guiding catheter, vessel tortuosity and severe calcification. Compared to predilation, direct stenting is associated with a higher risk of stent loss. Unfortunately, stent embolization can be a stressful experience, since the operators may not be familiar with retrieval equipment and techniques. Different percutaneous retrival techniques have been described to retrieve embolized stents from the coronary and peripheral circulation, including the use of low-profile balloon catheters, loop snares, two twisted guide wires, or retrieval devices. The use of small balloon catheters is effective, especially in cases where a stent is still riding on a guide wire and is deployed enough to advance a small-balloon catheter through its lumen.
S149
PP-177 CAN LAD OCCLUSION RESTORE LIMA GRAFT FLOW? 2 M.H. Tas¸ 1 , Z. Sim ¸ sek ¸ 1 , H. De˘girmenci1 , A. Colak ¸ , E. Bayram1 , 1 1 H. Senocak ¸ . Ataturk University, Department of Cardiology, Faculty of Medicine, Erzurum, Turkey; 2 Ataturk University, Department of Cardiovascular Surgery, Faculty of Medicine, Erzurum, Turkey Competetive flow is defined as competition of native arteries and grafts for distal perfusion after Coronary Artery Bypass Grafting (CABG) operation. Cause of this phenomenon is certainly unknown however it is affected by the degree of stenosis on diseased vessel, kind of the graft, diameter of graft vessel and anastomosed diseased vessel, injury of graft and technical inaccuracies. A 63-year-old male with typical chest pain applied to our policlinic. In his medical history 1 year ago patient underwent surgical revascularisation involving LIMA graft on LAD and a venous graft on RCA. Patient has got diabetes mellitus and hypertension. Pathologic Q waves seen on inferior derivations from his ECG. Cardiac markers were normal. Patient admitted to our cardiology clinic. Despite medications patient’s chest pain continued. Patient has undergone coronary angiography. 70% stenosis in proximal LAD on cranial position found. There were no flow in LIMA graft (Figure 1A). A stent was implanted to LAD and TIMI 3 flow restored (Figure 1B). Patient discharged from hospital with medications. Five months later patient applied to our policlinic with exercise induced angina. We learned that patient didn’t take his drugs regularly. And a new coronary angiography performed. 90% in-stent restenosis found in LAD (Figure 1C). But LIMA-LAD bypass was seen patent (Figure 1D). We thought that current situation originated from the competitive flow between LIMA graft and native LAD. Patient’s medical treatment arranged again and discharged from the hospital. For this case if you are deciding for CABG it is important to evaluate coronary lesions correctly for prevention of coronary competitive flow.
Figure 1.
Figure: Successful stent retrieval. Coronary angiography; total occlusion of right coronary artery just before the right ventricular branch (A). After successful stenting, another stent was advanced through the first one for the distal lesion, however it stuck in the first stent (B,C). We successfully removed dislodged stent with a lower profile balloon (D).
PP-178 AN INTERESTING AND RARE COINCIDENCE IN CORONARY ARTERY DISEASE M. Koleoglu1 , S. Koro˘ ¨ glu2 , A. Suner3 , A. Nacar4 , H. Kaya5 , B. Altun6 , E. Aksu7 , A. Sokmen8 . 1 Department of Cardiology, Elbistan Yasam Hospital, Kahramanmaras, Turkey; 2 Department of Cardiology, Afsin State Hospital, Kahramanmaras, Turkey; 3 Department of Cardiology, Adiyaman University, Adiyaman, Turkey; 4 Department of Cardiology, Elbistan State Hospital, Kahramanmaras, Turkey; 5 Department of Cardiology, Park Hospital, Adiyaman, Turkey; 6 Department of Cardiology, Onsekiz Mart University, Canakkale, Turkey; 7 Department of Cardiology, Necip Fazil City Hospital, Kahramanmaras, Turkey; 8 Department of Cardiology, Sutcu Imam University, Kahramanmaras, Turkey Introduction: Coronary artery disease (CAD) and its main complication, myocardial infarction, have a strong genetic basis. Herein, we report an interesting family in which the three members diagnosed as acute coronary syndrome and their affected coronary segments are same. Case report: A 90-year-old woman admitted to emergency department with chest pain, her coronary angiogram showed
Case: A 65-year-old man with a history of hypertension and hyperlipydemia admitted to our center with subacute inferior myocardial infarction. Coronary angiography showed total occlusion of right coronary artery (RCA) before the right ventricular branch. After stent implantation to infarct related lesion we assessed a severe stenosis in distal RCA and decided to implant a 3.25×10 mm stent to this lesion. However the stent was stuck in the prior stent and then slipped half way off from the balloon catheter. We tried to advance the balloon inside of the slipped stent but failed. We decided to use a smaller balloon. A 1.5×20-mm balloon catheter was advanced through the guide wire and then through the the slipped-stent. We inflated the balloon to 3-atm and started to retrieve the stent-balloon complex into the guiding catheter. The slipped stent was withdrawn uneventfully and a 3.0×20 mm stent implanted to the target lesion after predilatation. Discussion: Stent dislodgement from the delivery system most often occurs when the stent balloon assembly is pulled back into the guiding catheter, or when the target lesion cannot be passed due to unfavorable anatomy. Factors predisposing to the inability of stent delivery are poor support of the guiding catheter, vessel tortuosity and severe calcification. Compared to predilation, direct stenting is associated with a higher risk of stent loss. Unfortunately, stent embolization can be a stressful experience, since the operators may not be familiar with retrieval equipment and techniques. Different percutaneous retrival techniques have been described to retrieve embolized stents from the coronary and peripheral circulation, including the use of low-profile balloon catheters, loop snares, two twisted guide wires, or retrieval devices. The use of small balloon catheters is effective, especially in cases where a stent is still riding on a guide wire and is deployed enough to advance a small-balloon catheter through its lumen.
S149
PP-177 CAN LAD OCCLUSION RESTORE LIMA GRAFT FLOW? 2 M.H. Tas¸ 1 , Z. Sim ¸ sek ¸ 1 , H. De˘girmenci1 , A. Colak ¸ , E. Bayram1 , 1 1 H. Senocak ¸ . Ataturk University, Department of Cardiology, Faculty of Medicine, Erzurum, Turkey; 2 Ataturk University, Department of Cardiovascular Surgery, Faculty of Medicine, Erzurum, Turkey Competetive flow is defined as competition of native arteries and grafts for distal perfusion after Coronary Artery Bypass Grafting (CABG) operation. Cause of this phenomenon is certainly unknown however it is affected by the degree of stenosis on diseased vessel, kind of the graft, diameter of graft vessel and anastomosed diseased vessel, injury of graft and technical inaccuracies. A 63-year-old male with typical chest pain applied to our policlinic. In his medical history 1 year ago patient underwent surgical revascularisation involving LIMA graft on LAD and a venous graft on RCA. Patient has got diabetes mellitus and hypertension. Pathologic Q waves seen on inferior derivations from his ECG. Cardiac markers were normal. Patient admitted to our cardiology clinic. Despite medications patient’s chest pain continued. Patient has undergone coronary angiography. 70% stenosis in proximal LAD on cranial position found. There were no flow in LIMA graft (Figure 1A). A stent was implanted to LAD and TIMI 3 flow restored (Figure 1B). Patient discharged from hospital with medications. Five months later patient applied to our policlinic with exercise induced angina. We learned that patient didn’t take his drugs regularly. And a new coronary angiography performed. 90% in-stent restenosis found in LAD (Figure 1C). But LIMA-LAD bypass was seen patent (Figure 1D). We thought that current situation originated from the competitive flow between LIMA graft and native LAD. Patient’s medical treatment arranged again and discharged from the hospital. For this case if you are deciding for CABG it is important to evaluate coronary lesions correctly for prevention of coronary competitive flow.
Figure 1.
Figure: Successful stent retrieval. Coronary angiography; total occlusion of right coronary artery just before the right ventricular branch (A). After successful stenting, another stent was advanced through the first one for the distal lesion, however it stuck in the first stent (B,C). We successfully removed dislodged stent with a lower profile balloon (D).
PP-178 AN INTERESTING AND RARE COINCIDENCE IN CORONARY ARTERY DISEASE M. Koleoglu1 , S. Koro˘ ¨ glu2 , A. Suner3 , A. Nacar4 , H. Kaya5 , B. Altun6 , E. Aksu7 , A. Sokmen8 . 1 Department of Cardiology, Elbistan Yasam Hospital, Kahramanmaras, Turkey; 2 Department of Cardiology, Afsin State Hospital, Kahramanmaras, Turkey; 3 Department of Cardiology, Adiyaman University, Adiyaman, Turkey; 4 Department of Cardiology, Elbistan State Hospital, Kahramanmaras, Turkey; 5 Department of Cardiology, Park Hospital, Adiyaman, Turkey; 6 Department of Cardiology, Onsekiz Mart University, Canakkale, Turkey; 7 Department of Cardiology, Necip Fazil City Hospital, Kahramanmaras, Turkey; 8 Department of Cardiology, Sutcu Imam University, Kahramanmaras, Turkey Introduction: Coronary artery disease (CAD) and its main complication, myocardial infarction, have a strong genetic basis. Herein, we report an interesting family in which the three members diagnosed as acute coronary syndrome and their affected coronary segments are same. Case report: A 90-year-old woman admitted to emergency department with chest pain, her coronary angiogram showed