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TCTAP C-055 The Application of Bioabsorbable Stent in a Balloon - Unexpandable Calcified CTO Lesion in a Stage 5 CKD Patient
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Fourbioresorbable vascular scaffolds (BVS) (3.5x18mm, 3.5x28mm, 3.0x28mm, 2.5x28mm) were deployed from the proximal to distal LAD with minimal overlap (Figure 3). Optical coherence tomography (OCT) showed the stents was well apposedwith no stent edge dissection (Figure 3A, 3B and 3C). Seven month later, follow-up coronary angiography ectatic change with aneurysms formation over midand distal segment of RCA, which was prior false lumen site. Proximal to midLAD also had several small sized aneurysms at proximal and mid LAD. OCT showedwell expanded BVS at ectatic dilatation site, and coronary aneurysm. Dualantiplatelet therapy was planned to long-term use to prevent thrombus formation.
TCTAP C-055 The Application of Bioabsorbable Stent in a Balloon - Unexpandable Calcified CTO Lesion in a Stage 5 CKD Patient Wei-Chun Huang,1 Chin-Chang Cheng,1 Cheng-Hung Chiang,1 Cheng Chung Hung,2 Feng Yu Kuo,1 Guang-Yuan Mar,1 Chun-Peng Liu1 1 Kaohsiung Veterans General Hospital, Taiwan; 2Kaohsiung Veteran General Hospital, Pingtung Branch, Taiwan [CLINICAL INFORMATION] Patient initials or identifier number. 4729117 Relevant clinical history and physical exam. An 82 year-old male has multiple risk factors, including hypertension, diabetes mellitus, dyslipidemia and smoking. He also suffered from stage 5 chronic kidney disease. He suffered from chest tightness off and on in recent one month. Relevant test results prior to catheterization. Thallium-201 stress myocardial perfusion scan showed reversible defect in apical-to-basal anteroseptal wall.
Relevant catheterization findings. Coronary angiogram showed CTO lesion.
Case Summary. The incidence of coronary artery aneurysms after DES implantation is low within the first 9 months, with a reported incidence of 0.2% to 2.3%. We shared an interesting case and image about coronary aneurysms within EES and BVS.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
[INTERVENTIONAL MANAGEMENT] Procedural step. The Fileder FC wire was used under the support of finecross microcatheter. Because of difficult to cross the calcified CTO lesion, Ultimatebros 3 and Conquest Pro wire were used via parallel wire technique. After one hour, we finally found the true lumen via Conquest Pro wire. However, it is very difficult to advance mini-trek 1.2/10 mm balloon. Anchor balloon technique from LCX was also used for 4 times. During the course, four Sapphire II 1/6mm balloon and two mini-trek 1.2/10 mm were used to try to open the lesion, but still failed. Because 200ml contrast medium were used, we decided to stop the procedure and arrange temporal hemodialysis for the patient to remove contrast medium and preserve renal function. He was discharged 2 days later without continuous hemodialysis. After discharge, he suffered from recurrent chest pain again and visited our emergent department. Because the patient refused CABG, we arrange another PCI for him 2 months later. However, we still spend 40 minutes to find the true lumen via Ultimatebro 3 wire. Then, we advanced finecross as deep as possible and removed the Ultimatebro 3 wire. Then, we can successfully advanced Rota wire to distal portion of LAD. Rotablation with 1.25mm burr used was used to open the calcified lesion. After 2.0mm balloon dilatation, IVUS showed severe calcified lesion. We used NC trek 3.0/20mm balloon to break calcification. Therefore, we can successful deliver bioabsorbable stent into LAD. Post dilatation and IVUS were used.
S145
Case Summary. In conclusion, after adequate preparation, BVS in selected CTO case is safe. Rota wire can cross the balloon unexpandable lesion via step by step technique. Temporal hemodialysis after
S146
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
cardiac catheterization may prevent contrast nephropathy in Stage 5 chronic kidney disease. IVUS or OCT in important to assess pre and post BVS implanted vessels. TCTAP C-056 Implantation of Bioresorbable Vascular Scaffold After Rotational Atherectomy in Patient with Heavy Calcified Coronary Stenosis Seung Hwa Lee,1 Joo-Yong Hahn,1 Jeong Hoon Yang,1 Young Bin Song,1 Jin-Ho Choi,1 Seung Hyuk Choi,1 Hyeon-Cheol Gwon,1 Sang Hoon Lee1 1 Samsung Medical Center, Korea (Republic of) [CLINICAL INFORMATION] Patient initials or identifier number. KSH Relevant clinical history and physical exam. Male/58 years old Chest pain for 1 week; CCS class III No underlying disease No family history Smoker, 40 pack-year BP 115/80 mmHg, HR 53/min RR 20/min, BT 36.5 C, SpO2 97% (room air) R/O angina pectoris
[INTERVENTIONAL MANAGEMENT] Procedural step. We performed diagnostic coronary angiography. Theproximal left anterior descending artery showed diffuse stenosis up to 90% with heavy calcification, and proximal left circumflex artery showed segmentalstenosis up to 50%. And mid right coronary artery showed chronic totalocclusion. We planned second stage PCI to perform rotational atherectomy atproximal LAD. Rotational atherectomy was done with 1.25mm burr at proximal left anteriordescending artery, and followed by 1.75mm burr. IVUS was done atproximal leftanterior descending artery. After rotational atherectomy, we dilated a 2.5x20mm balloon, and stepped up with 3.0x20mm balloon. After balloon dilatation, we implanted 2.5x28mm Absorbbioreabsorbable vascular scaffold. Adjunctive balloon dilatation was done with 3.5x15mm non-compliant balloon. After procedure, we found dye stating at far distal left anterior descending artery. But, echocardiography showedno pericardial effusion.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Fourbioresorbable vascular scaffolds (BVS) (3.5x18mm, 3.5x28mm, 3.0x28mm, 2.5x28mm) were deployed from the proximal to distal LAD with minimal overlap (Figure 3). Optical coherence tomography (OCT) showed the stents was well apposedwith no stent edge dissection (Figure 3A, 3B and 3C). Seven month later, follow-up coronary angiography ectatic change with aneurysms formation over midand distal segment of RCA, which was prior false lumen site. Proximal to midLAD also had several small sized aneurysms at proximal and mid LAD. OCT showedwell expanded BVS at ectatic dilatation site, and coronary aneurysm. Dualantiplatelet therapy was planned to long-term use to prevent thrombus formation.
TCTAP C-055 The Application of Bioabsorbable Stent in a Balloon - Unexpandable Calcified CTO Lesion in a Stage 5 CKD Patient Wei-Chun Huang,1 Chin-Chang Cheng,1 Cheng-Hung Chiang,1 Cheng Chung Hung,2 Feng Yu Kuo,1 Guang-Yuan Mar,1 Chun-Peng Liu1 1 Kaohsiung Veterans General Hospital, Taiwan; 2Kaohsiung Veteran General Hospital, Pingtung Branch, Taiwan [CLINICAL INFORMATION] Patient initials or identifier number. 4729117 Relevant clinical history and physical exam. An 82 year-old male has multiple risk factors, including hypertension, diabetes mellitus, dyslipidemia and smoking. He also suffered from stage 5 chronic kidney disease. He suffered from chest tightness off and on in recent one month. Relevant test results prior to catheterization. Thallium-201 stress myocardial perfusion scan showed reversible defect in apical-to-basal anteroseptal wall.
Relevant catheterization findings. Coronary angiogram showed CTO lesion.
Case Summary. The incidence of coronary artery aneurysms after DES implantation is low within the first 9 months, with a reported incidence of 0.2% to 2.3%. We shared an interesting case and image about coronary aneurysms within EES and BVS.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
[INTERVENTIONAL MANAGEMENT] Procedural step. The Fileder FC wire was used under the support of finecross microcatheter. Because of difficult to cross the calcified CTO lesion, Ultimatebros 3 and Conquest Pro wire were used via parallel wire technique. After one hour, we finally found the true lumen via Conquest Pro wire. However, it is very difficult to advance mini-trek 1.2/10 mm balloon. Anchor balloon technique from LCX was also used for 4 times. During the course, four Sapphire II 1/6mm balloon and two mini-trek 1.2/10 mm were used to try to open the lesion, but still failed. Because 200ml contrast medium were used, we decided to stop the procedure and arrange temporal hemodialysis for the patient to remove contrast medium and preserve renal function. He was discharged 2 days later without continuous hemodialysis. After discharge, he suffered from recurrent chest pain again and visited our emergent department. Because the patient refused CABG, we arrange another PCI for him 2 months later. However, we still spend 40 minutes to find the true lumen via Ultimatebro 3 wire. Then, we advanced finecross as deep as possible and removed the Ultimatebro 3 wire. Then, we can successfully advanced Rota wire to distal portion of LAD. Rotablation with 1.25mm burr used was used to open the calcified lesion. After 2.0mm balloon dilatation, IVUS showed severe calcified lesion. We used NC trek 3.0/20mm balloon to break calcification. Therefore, we can successful deliver bioabsorbable stent into LAD. Post dilatation and IVUS were used.
S145
Case Summary. In conclusion, after adequate preparation, BVS in selected CTO case is safe. Rota wire can cross the balloon unexpandable lesion via step by step technique. Temporal hemodialysis after
S146
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
cardiac catheterization may prevent contrast nephropathy in Stage 5 chronic kidney disease. IVUS or OCT in important to assess pre and post BVS implanted vessels. TCTAP C-056 Implantation of Bioresorbable Vascular Scaffold After Rotational Atherectomy in Patient with Heavy Calcified Coronary Stenosis Seung Hwa Lee,1 Joo-Yong Hahn,1 Jeong Hoon Yang,1 Young Bin Song,1 Jin-Ho Choi,1 Seung Hyuk Choi,1 Hyeon-Cheol Gwon,1 Sang Hoon Lee1 1 Samsung Medical Center, Korea (Republic of) [CLINICAL INFORMATION] Patient initials or identifier number. KSH Relevant clinical history and physical exam. Male/58 years old Chest pain for 1 week; CCS class III No underlying disease No family history Smoker, 40 pack-year BP 115/80 mmHg, HR 53/min RR 20/min, BT 36.5 C, SpO2 97% (room air) R/O angina pectoris
[INTERVENTIONAL MANAGEMENT] Procedural step. We performed diagnostic coronary angiography. Theproximal left anterior descending artery showed diffuse stenosis up to 90% with heavy calcification, and proximal left circumflex artery showed segmentalstenosis up to 50%. And mid right coronary artery showed chronic totalocclusion. We planned second stage PCI to perform rotational atherectomy atproximal LAD. Rotational atherectomy was done with 1.25mm burr at proximal left anteriordescending artery, and followed by 1.75mm burr. IVUS was done atproximal leftanterior descending artery. After rotational atherectomy, we dilated a 2.5x20mm balloon, and stepped up with 3.0x20mm balloon. After balloon dilatation, we implanted 2.5x28mm Absorbbioreabsorbable vascular scaffold. Adjunctive balloon dilatation was done with 3.5x15mm non-compliant balloon. After procedure, we found dye stating at far distal left anterior descending artery. But, echocardiography showedno pericardial effusion.