Late Stent Malapposition after Cypher Stent Implantation

- Operator : Cheol Whan Lee

Late Stent Malapposition after Cypher Stent Implantation
- Operator: Cheol Whan Lee, MD
Case presentation
This 36 year-old man was admitted for resting chest pain for 2 weeks. His coronary risk factors were family history and smoking. Baseline echocardiography showed moderate LV dysfunction with ejection fraction of 42% and hypokinesia of inferoposterior wall and apical septum.
Baseline coronary angiography
Left coronary angiogram showed a diffuse stenosis of the middle left anterior descending artery (LAD) and total occlusion of the distal left circumflex artery (LCX) (Figure 1, Figure 2).
Procedure
An 8F sheath was inserted through the right femoral artery, and the left coronary ostium was engaged with an 8F JL catheter with 4.0cm curve. The LCX lesion was treated with two overlapped Cypher stents (3.0 X 13 / 3.5 X 33 mm) (Figure 3). Then a 0.014 inch Choice PT wire was inserted into the LAD. Predilation was performed with a 3.0 X 15 mm Stormer balloon at 6 atm to 2.87 mm. After predilation, a Cypher stent (3.5 X 33 mm) was placed and deployed at 20 atm to 3.9 mm (Figure 4). Final angiogram and intravascular ultrasound (IVUS) showed a well-expanded stent without inapposition (Figure 5, Figure 6).
Follow-up angiography and IVUS
Follow-up angiography and IVUS were performed through radial approach. The angiogram showed no evidence of restenosis in stented segments and contrast stasis at peri-stent area of the middle LAD. IVUS showed significant malappositon at the LAD stent (Figure 7, Figure 8). He was administered with an antiplatelet combination including aspirin and clopidogrel. Repeat intervention was not intended.

Comments

  • Zheng zhen guo 2005-04-20 How about the duration of follow-up? How about IVUS analysis of LCX in follow-up angiography?
  • Marcelo Ribeiro 2005-04-22
  • Marcelo Ribeiro 2005-04-22 What about the causes of late stent malapposition?Certainly it brings questions of an undesirable collateral effect of sirolimus on the inner layers of the vessel wall, but at least in SIRIUS it did not translate in adverse outcomes.But if this patient were older, problems of a prolonged dual anti platelet therapy could appear.
  • Debabrata Dash 2005-04-22 what is the definition of late malapposition?How late it is?Do U see the role of dilation with a bigger ballon or hugging ballon technique? Dr D DASH MD DM TOYOHASHI JAPAN
  • Young-Hak Kim 2005-05-06 Late stent inapposition is one of negative concerns in the DES era. In the previous reports, the cause may be the positive remodeling of coronary vessels. However, the exact incidence or precipitating factors in real world practice is not known well. Others are shown in the reviews.
  • Jingyu Hang 2005-05-06 What is the clinical implication of late malapposition ?Is there any sound evidence that relates it to thrombosis?
  • Young-Hak Kim 2005-05-09 During follow-up period in lots of patients, we did not find any evidence of serious complications caused by late malapposition. However, probability has not been erased.

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