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Elective Stenting with Embolic Protection(PercuSurge GuardWire) in a Patient with Non-ST elevation
- Operator : Myeong-Ki Hong, MD
Case presentation
The patient was a 64 year-old female. She had recent onset (2-3 days) of chest pain. She had hypertension as a coronary risk factor. Baseline ECG showed T wave inversion in leads II and aVF. Cardiac enzymes were elevated on admission. Echocardiography showed good LV function with an EF of 60%.
Baseline coronary angiography

1. Coronary angiogram showed total occlusion of proximal RCA with TIMI 0 flow. The RCA had a large burden of thrombus overlying the lesion (Figure 1).

2. The LCX and LAD were normal (Figure 2).

Procedure
An 8F sheath was inserted through the right femoral artery and the right coronary artery was engaged with an 8F Judkins catheter. After coronary angiography, a distal protection device (PercuSurge) was deployed in an attempt to prevent distal embolization following intervention. Once complete distal occlusion of distal RCA was verified (Figure 3, black arrow indicate inflated distal protection balloon with contrast injection), the large burden of thrombus in the RCA was initially aspirated using an export catheter. The following angiogram revealed a tubular 70% luminal narrowing in mid RCA. Without predilatation, a 18mm x 4mm S7 stent was implanted in the mid RCA lesion under distal protection (Figure 4). Following stent implantation, the stagnant blood and debris in the RCA were aspirated using an export catheter (Figure 5). This procedure was facilitated by using a guiding catheter with side holes. The final angiogram showed successful stent implantation without residual stenosis or dissection. TIMI 3 flow was noted (Figure 6). and there was no evidence of distal embolization. Cardiac enzymes levels remained within the normal range and the patient was discharged two days later. Figure 7 shows a micro-filter containing some of the aspirated debris particles, which were shown to be composed of fibrin strands (thrombus) on pathologic examination.
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