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TCTAP C-225 Application of BVS in a RCA CTO Lesion
S376
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Relevant test results prior to catheterization. Treadmil’s test: positive Relevant catheterization findings. RCA CTO [INTERVENTIONAL MANAGEMENT] Procedural step. Trans-radial and trans-femoral puncture were done. The RCA CTO lesion was noted. AL 1 short tip guild catheter with fielder XT wire under Finecross microcatheter support. Due to poor penetration, we switch to Ultimate bro 3 wire, and puncture was done via progress 140T wire. Finally we went into distal true lumen, and IVUS was done. After sequential POBA, the BVS was deployed smoothly. We checked the in-stent lesion with IVUS. Three months and one year following showed patent in-stent lesion. OCT exam was done.
Case Summary. We experienced a impressive case of large thrombus observed with 3D OFDI. Careful reading of OFDI image is important not only to avoid stent malapposition but also to find the thrombus. 3D reconstruction needs a little time and effort, but it gives us a vivid image. TCTAP C-225 Application of BVS in a RCA CTO Lesion Cheng Chung Hung1 Kaohsiung Veteran General Hospital, Pingtung Branch, Taiwan
1
[CLINICAL INFORMATION] Patient initials or identifier number. Mr. Chiang Relevant clinical history and physical exam. 57-year-old man, dylipidemia and smoker, no hypertenion or diabetes, complained of chest tightness off and on recently BP 130/70, HR 74, Clear breathing sound, regular heartbeat, no leg edema – ecg showed VPCs
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S377
Final angiogram and OFDI showed satisfactory results. However, on further detailed review of the OFDI image of the previous stent in retrospect, unique S-shaped connectors (attached image: S connector in OFDI) were noted at peak-to-peak linkage points. These connectors are actually characteristic of Biomatrix stent and are absent in Resolute Integrity stent, though both stent designs are otherwise similar.
Case Summary. Trans-radial and trans-femoral puncture were done. The RCA CTO lesion was noted. AL 1 short tip guild catheter with fielder XT wire under Finecross microcatheter support. Due to poor penetration, we switch to Ultimate bro 3 wire, and puncture was done via progress 140T wire. Finally we went into distal true lumen, and IVUS was done. After sequential POBA, the BVS was deployed smoothly. We checked the in-stent lesion with IVUS. Three months and one year following showed patent in-stent lesion. OCT exam was done. TCTAP C-226 Which Stent Should I Implant This Time? - Additional Role of Optical Frequency Domain Imaging in the Treatment of In-Stent-Restenosis Hiu Lam Chan,1 Kin Lam Tsui,1 Dick Chi Yeung Cheung,1 Kwok Leung Wu,1 Joe Kin-Tong Lee,1 Kwok Keung Chan1 1 Pamela Youde Nethersole Eastern Hospital, Hong Kong, China [CLINICAL INFORMATION] Patient initials or identifier number. SF Wu Relevant clinical history and physical exam. Madam Wu, a 63-year-old woman who has history of hyperlipidaemia. She had history of ischaemic heart disease and had a percutaneous angioplasty performed in London in 2013 (Drug-eluting stent was implanted in the proximal LAD). She presented with sudden onset of exertional chest pain on 15 July 2015. Her haemodynamics were stable, heart sound was normal, there was no murmur. She was not in heart failure. Relevant test results prior to catheterization. ECG showed sinus rhythm, no ST changes. Cardiac enzymes were not raised. Relevant catheterization findings. Coronary angiogram showed severe in-stent-restenosis at the proximal left descending artery (LAD) stent. There was also subtotal occlusion of the first diagonal branch (D1). [INTERVENTIONAL MANAGEMENT] Procedural step. The coronary intervention (PCI) strategy targeted at using a different DES. However, the PCI report was unavailable since the procedure was performed in another country. EBU 6/3.5 guiding catheter provided satisfactory support to the left coronary artery (LAD). LAD and first diagonal branch (D1) were wired. OFDI was performed to study LAD lesion. Optical Frequency Domain Imaging (OFDI) (attached image: OFDI image 1) with 3D image reconstruction was performed in attempt to identify the previous LAD stent. The CARPET view of OFDI did show up the pattern of the stent strut as “out-of-phase, peak-to-peak” design. At a glance, it was indicative of Resolute Integrity stent. Therefore, we planned to treat the ISR with another stent with different drug. LAD lesion and D1 lesion were predilated, followed by implantation of a Biomatrix stent at the proximal LAD. Kissing balloon dilatation was performed at the LAD and D1. Finally, high pressure balloon dilatation at the stent was performed.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Relevant test results prior to catheterization. Treadmil’s test: positive Relevant catheterization findings. RCA CTO [INTERVENTIONAL MANAGEMENT] Procedural step. Trans-radial and trans-femoral puncture were done. The RCA CTO lesion was noted. AL 1 short tip guild catheter with fielder XT wire under Finecross microcatheter support. Due to poor penetration, we switch to Ultimate bro 3 wire, and puncture was done via progress 140T wire. Finally we went into distal true lumen, and IVUS was done. After sequential POBA, the BVS was deployed smoothly. We checked the in-stent lesion with IVUS. Three months and one year following showed patent in-stent lesion. OCT exam was done.
Case Summary. We experienced a impressive case of large thrombus observed with 3D OFDI. Careful reading of OFDI image is important not only to avoid stent malapposition but also to find the thrombus. 3D reconstruction needs a little time and effort, but it gives us a vivid image. TCTAP C-225 Application of BVS in a RCA CTO Lesion Cheng Chung Hung1 Kaohsiung Veteran General Hospital, Pingtung Branch, Taiwan
1
[CLINICAL INFORMATION] Patient initials or identifier number. Mr. Chiang Relevant clinical history and physical exam. 57-year-old man, dylipidemia and smoker, no hypertenion or diabetes, complained of chest tightness off and on recently BP 130/70, HR 74, Clear breathing sound, regular heartbeat, no leg edema – ecg showed VPCs
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S377
Final angiogram and OFDI showed satisfactory results. However, on further detailed review of the OFDI image of the previous stent in retrospect, unique S-shaped connectors (attached image: S connector in OFDI) were noted at peak-to-peak linkage points. These connectors are actually characteristic of Biomatrix stent and are absent in Resolute Integrity stent, though both stent designs are otherwise similar.
Case Summary. Trans-radial and trans-femoral puncture were done. The RCA CTO lesion was noted. AL 1 short tip guild catheter with fielder XT wire under Finecross microcatheter support. Due to poor penetration, we switch to Ultimate bro 3 wire, and puncture was done via progress 140T wire. Finally we went into distal true lumen, and IVUS was done. After sequential POBA, the BVS was deployed smoothly. We checked the in-stent lesion with IVUS. Three months and one year following showed patent in-stent lesion. OCT exam was done. TCTAP C-226 Which Stent Should I Implant This Time? - Additional Role of Optical Frequency Domain Imaging in the Treatment of In-Stent-Restenosis Hiu Lam Chan,1 Kin Lam Tsui,1 Dick Chi Yeung Cheung,1 Kwok Leung Wu,1 Joe Kin-Tong Lee,1 Kwok Keung Chan1 1 Pamela Youde Nethersole Eastern Hospital, Hong Kong, China [CLINICAL INFORMATION] Patient initials or identifier number. SF Wu Relevant clinical history and physical exam. Madam Wu, a 63-year-old woman who has history of hyperlipidaemia. She had history of ischaemic heart disease and had a percutaneous angioplasty performed in London in 2013 (Drug-eluting stent was implanted in the proximal LAD). She presented with sudden onset of exertional chest pain on 15 July 2015. Her haemodynamics were stable, heart sound was normal, there was no murmur. She was not in heart failure. Relevant test results prior to catheterization. ECG showed sinus rhythm, no ST changes. Cardiac enzymes were not raised. Relevant catheterization findings. Coronary angiogram showed severe in-stent-restenosis at the proximal left descending artery (LAD) stent. There was also subtotal occlusion of the first diagonal branch (D1). [INTERVENTIONAL MANAGEMENT] Procedural step. The coronary intervention (PCI) strategy targeted at using a different DES. However, the PCI report was unavailable since the procedure was performed in another country. EBU 6/3.5 guiding catheter provided satisfactory support to the left coronary artery (LAD). LAD and first diagonal branch (D1) were wired. OFDI was performed to study LAD lesion. Optical Frequency Domain Imaging (OFDI) (attached image: OFDI image 1) with 3D image reconstruction was performed in attempt to identify the previous LAD stent. The CARPET view of OFDI did show up the pattern of the stent strut as “out-of-phase, peak-to-peak” design. At a glance, it was indicative of Resolute Integrity stent. Therefore, we planned to treat the ISR with another stent with different drug. LAD lesion and D1 lesion were predilated, followed by implantation of a Biomatrix stent at the proximal LAD. Kissing balloon dilatation was performed at the LAD and D1. Finally, high pressure balloon dilatation at the stent was performed.