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Late Stent Malapposition After Debulking Atherectomy and Elective Stenting with Bare Metal Stent
- Operator: Myeong-Ki Hong, MD, PhD, Korea
Case presentation
The patient was 67 year-old male. He was presented with unstable angina. He had a hypertension as a coronary risk factor. Baseline ECG showed T wave inversion in leads V2-V6. Echocardiography showed good LV function with an EF of 65%. Baseline coronary angiogram before the index-procedure showed diffuse stenoses at the proximal LAD and the proximal circumflex artery (Figure 1). After debulking atherectomy for effective removal of abundant atheroma (Figure 2), a 4.0x25 mm NIR stent was implanted with final kissing balloon dilatation at the proximal LAD lesion (Figure 3). Then, we performed a 3.5x18 mm Cross-Flex stent implantation at the proximal circumflex lesion (Figure 4). Post-procedural angiography showed successful results (Figure 5).
Six-month follow-up angiographic and IVUS study
Routine angiographic follow-up study was done 6 months after the index-procedure. It showed a sacular dilatation at the proximal LAD stent without limunal narrowing (Figure 6, arrow), where the IVUS exam showed a late stent malapposition (Figure 7). The patient was discharged with a continuous dual antiplatelet combination of aspirin and plavix.
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