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TCTAP C-083 A Perfect BVS Overlap with OCT Guidance
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
S171
After rewiring into a diagonal branch, balloon angioplasty was performed to diagonal ostium with Orbus Neich Sapphire 2 x 15 at 10 atm. The IVUS image of LCX and LAD checked. IVUS showed that the LAD ostium was not covered by the stent, and there was significant stenosis at the LCX ostium. So another BRS (Abbott BVS 3 x 18 mm) was deployed to proximal LCX, following by post-dilatation. A DES (Abbott Xience Xpedition 3.5 x 15 mm) deployed from distal LAD to LAD. Postdilatation to LM stent with Abbott NC TREK 4 x 8 mm at 14 atm and kissing balloon technique were smoothly performed. The final angiography showed good result. One month later, the patient admitted for RCA intervention. The previous stents were checked by OCT. The OCT revealed good stent opposition and expansion of LM-LAD, LAD, and LCX.
Case Summary. There are few experiences regarding BRS for LM disease. Crush or mini-crush techniques in BRS stenting previously considered contraindicated. We presented a case with successfully hybrid mini-crush procedure with DES and BRS which, resulted in well coverage of lesions without damages of BRS structures. Carefully managing LM disease with BRS plus kissing balloon techniques, hybrid stenting or even crush techniques is effective for bifurcation lesions. TCTAP C-082 Case Withdrawn TCTAP C-083 A Perfect BVS Overlap with OCT Guidance Cho Shan Li,1 Ho Lam1 Tuen Mun Hospital, Hong Kong, China
1
[CLINICAL INFORMATION] Patient initials or identifier number. LKK Relevant clinical history and physical exam. A 50-year-old male presents with stable angina symptom. There is no heart failure symptom. Physical exam shows BP 140/80 and P 70/min. Heart sound is normal with no murmur. Chest is clear. Bilateral radial pulses have no delay. Relevant test results prior to catheterization. Blood test including cardiac markers, CXR, ECG and Echo are unremarkable. Relevant catheterization findings. LM normal mid-LAD long lesion with maximal 80% stenosis. LCX and RCA are normal. [INTERVENTIONAL MANAGEMENT] Procedural step. We decide to perform stenting with BVS. OCT shows the lesion length is 39 mm and lesion size is w3 mm. We choose 2 BVS of 2.5 x 28 mm and 2.5 x 12 mm, aiming for a 1 mm stent minimal overlap.The trick is to understand well about the distance from balloon markers and bead markers to stent edge. The distance between proximal stent edge to proximal bead marker is 0.8 mm after deployment of stent, while the distance between distal stent edge and distal bead marker is 0.3 mm. We first deploy the 2.5 x 28 mm BVS distally, then deploy the 2.5 x 12 mm BVS proximally when the distal balloon marker is just distal to the proximal bead marker of the distal stent (mid part of balloon marker coincides with the distal edge of bead), such that the distal bead marker of proximal stent is nearly touching the proximal bead marker of distal BVS. This will result in a w1 mm BVS stent overlap.
S172
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
In OCT, we can see there are 5 phases from distal to the proximal stent. In the first phase, normal stent struts of distal BVS are seen. In the second phase, there are 2-3 frames of stent strut loosening, corresponding to the last stent coil of the distal stent. In the third phase, there are 4-5 frames of stent overlap, corresponding to the ‘1 mm’ BVS overlap. In the fourth phase, there are again 2-3 frames of stent strut loosening, corresponding to the distal coil of the proximal stent with no more stent strut from the distal stent seen. In the fifth phase, there are normal stent struts of the proximal BVS.
Case Summary. We finish this case by performing post-dilatation with NC balloon under OCT guidance. This case demonstrates the technique of minimal BVS overlap. It also illustrates the use of OCT appreciating the perfect BVS overlap, and its role in optimizing BVS post-dilatation. TCTAP C-084 Application of Bioresorbable Vascular Scaffolds and Drug Eluting Stent with T-STENTING and Small Protrusion (TAP) Technique in Bifurcation Lesion Tse-Husan Yang,1 Wei-Chun Huang,1 Chin-Chang Cheng,1 Cheng-Hung Chiang,1 Feng Yu Kuo,1 Guang-Yuan Mar,1 Chun-Peng Liu1 1 Kaohsiung veterans general hospital, Taiwan [CLINICAL INFORMATION] Patient initials or identifier number. Kao Relevant clinical history and physical exam. A 49 years old man complained about worsening chest tightness and effort related dyspnea in present weeks. He has a history of smoking, hypertension, dyslipidemia, and previous ACS with triple-vessel disease, treated by percutaneous coronary intervention with stent over LAD, LCX, and RCA. Relevant test results prior to catheterization. The myocardial perfusion scan revealed ischemia over antero-septal and infero-lateral wall.
S171
After rewiring into a diagonal branch, balloon angioplasty was performed to diagonal ostium with Orbus Neich Sapphire 2 x 15 at 10 atm. The IVUS image of LCX and LAD checked. IVUS showed that the LAD ostium was not covered by the stent, and there was significant stenosis at the LCX ostium. So another BRS (Abbott BVS 3 x 18 mm) was deployed to proximal LCX, following by post-dilatation. A DES (Abbott Xience Xpedition 3.5 x 15 mm) deployed from distal LAD to LAD. Postdilatation to LM stent with Abbott NC TREK 4 x 8 mm at 14 atm and kissing balloon technique were smoothly performed. The final angiography showed good result. One month later, the patient admitted for RCA intervention. The previous stents were checked by OCT. The OCT revealed good stent opposition and expansion of LM-LAD, LAD, and LCX.
Case Summary. There are few experiences regarding BRS for LM disease. Crush or mini-crush techniques in BRS stenting previously considered contraindicated. We presented a case with successfully hybrid mini-crush procedure with DES and BRS which, resulted in well coverage of lesions without damages of BRS structures. Carefully managing LM disease with BRS plus kissing balloon techniques, hybrid stenting or even crush techniques is effective for bifurcation lesions. TCTAP C-082 Case Withdrawn TCTAP C-083 A Perfect BVS Overlap with OCT Guidance Cho Shan Li,1 Ho Lam1 Tuen Mun Hospital, Hong Kong, China
1
[CLINICAL INFORMATION] Patient initials or identifier number. LKK Relevant clinical history and physical exam. A 50-year-old male presents with stable angina symptom. There is no heart failure symptom. Physical exam shows BP 140/80 and P 70/min. Heart sound is normal with no murmur. Chest is clear. Bilateral radial pulses have no delay. Relevant test results prior to catheterization. Blood test including cardiac markers, CXR, ECG and Echo are unremarkable. Relevant catheterization findings. LM normal mid-LAD long lesion with maximal 80% stenosis. LCX and RCA are normal. [INTERVENTIONAL MANAGEMENT] Procedural step. We decide to perform stenting with BVS. OCT shows the lesion length is 39 mm and lesion size is w3 mm. We choose 2 BVS of 2.5 x 28 mm and 2.5 x 12 mm, aiming for a 1 mm stent minimal overlap.The trick is to understand well about the distance from balloon markers and bead markers to stent edge. The distance between proximal stent edge to proximal bead marker is 0.8 mm after deployment of stent, while the distance between distal stent edge and distal bead marker is 0.3 mm. We first deploy the 2.5 x 28 mm BVS distally, then deploy the 2.5 x 12 mm BVS proximally when the distal balloon marker is just distal to the proximal bead marker of the distal stent (mid part of balloon marker coincides with the distal edge of bead), such that the distal bead marker of proximal stent is nearly touching the proximal bead marker of distal BVS. This will result in a w1 mm BVS stent overlap.
S172
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
In OCT, we can see there are 5 phases from distal to the proximal stent. In the first phase, normal stent struts of distal BVS are seen. In the second phase, there are 2-3 frames of stent strut loosening, corresponding to the last stent coil of the distal stent. In the third phase, there are 4-5 frames of stent overlap, corresponding to the ‘1 mm’ BVS overlap. In the fourth phase, there are again 2-3 frames of stent strut loosening, corresponding to the distal coil of the proximal stent with no more stent strut from the distal stent seen. In the fifth phase, there are normal stent struts of the proximal BVS.
Case Summary. We finish this case by performing post-dilatation with NC balloon under OCT guidance. This case demonstrates the technique of minimal BVS overlap. It also illustrates the use of OCT appreciating the perfect BVS overlap, and its role in optimizing BVS post-dilatation. TCTAP C-084 Application of Bioresorbable Vascular Scaffolds and Drug Eluting Stent with T-STENTING and Small Protrusion (TAP) Technique in Bifurcation Lesion Tse-Husan Yang,1 Wei-Chun Huang,1 Chin-Chang Cheng,1 Cheng-Hung Chiang,1 Feng Yu Kuo,1 Guang-Yuan Mar,1 Chun-Peng Liu1 1 Kaohsiung veterans general hospital, Taiwan [CLINICAL INFORMATION] Patient initials or identifier number. Kao Relevant clinical history and physical exam. A 49 years old man complained about worsening chest tightness and effort related dyspnea in present weeks. He has a history of smoking, hypertension, dyslipidemia, and previous ACS with triple-vessel disease, treated by percutaneous coronary intervention with stent over LAD, LCX, and RCA. Relevant test results prior to catheterization. The myocardial perfusion scan revealed ischemia over antero-septal and infero-lateral wall.