BVS Stenting at Diffuse Long Lesion

- Operator : Duk-Woo Park

BVS Stenting at Diffuse Long Lesion

- Operator: Duk-Woo Park, MD

Case Presentation

A 65 year-old male patient was admitted for chest discomfort for 2 months. His coronary risk factor was ex-smoking, diabetes and hypertension. He underwent coronary computed tomographic angiography. There was severe stenosis at RCA and moderate stenosis at LAD. LM bifurcation. The physical exam was normal. The ECG and cardiac enzymes were unremarkable. Echocardiography showed no regional wall motion abnormality with normal left ventricular systolic function. We decided to stent with BVS.

Baseline Coronary Angiogram

Left and coronary angiogram showed moderate stenosis at proximal LAD, moderate stenosis at distal LAD and moderate stenosis at LCX. The FFR of LAD was 0.80 ( Movie 1, Movie 2). The right coronary angiogram showed severe diffuse at proximal to distal RCA ( Movie 3).

Procedure

A 7 Fr sheath was inserted thorough right femoral artery and, right coronary artery was engaged with a 7 Fr JR 4 guiding catheter. 0.014-inch Sion 180 cm wire was inserted into RCA. Predilation performed with BH PLUS 2.5 x 20 mm balloon and Angiosculpt 3.0 x 15 mm ( Movie 4, Movie 5). And then three Absorb GT1 BVS 3.5 x 28 mm and Absorb GT1 BVS 3.0 x 2.8 mm were successfully deployed at proximal RCA to distal RCA ( Movie 6, Movie 7, Movie 8). And additional NC balloon was performed by using NC TREK 3.0 x 15 mm at distal RCA and Emergy NC 3.5 x 15 mm at proximal to mid RCA ( Movie 9). Final angiogram and IVUS showed that the procedure was successful ( Movie 10). Appendix IVUS image of post-ballooning ( Movie 11), post stent implantation ( Movie 12) and final image ( Movie 13)