Slides
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. |
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