BRS Stenting at Diffuse Long Lesion

- Operator : Seung-Jung Park

BRS Stenting at Diffuse Long Lesion
- Operator: Seung-Jung Park, MD
Case Presentation
A 64 year-old male patient was hospitalized for effort chest pain started 6 months ago. He had a history of previous smoking, dyslipidemia and diabetes. The ECG showed normal sinus rhythm without significant abnormality. Echocardiography revealed no regional wall motion abnormality with normal left ventricular systolic function.
Baseline Coronary Angiogram
  1. Left coronary angiogram showed moderate stenosis at mid to distal LAD and mild stenosis at proximal LCX. The FFR of mid to distal LAD and proximal LCX lesion was 0.68 and 0.82, respectively. ( Movie 1, Movie 2)
  2. The right coronary angiogram showed moderate diffuse stenosis at proximal to mid RCA. The FFR of RCA lesion was 0.74. ( Movie 3)
Procedure
A 6 Fr sheath was inserted thorough the right radial artery and left coronary artery was engaged with a 6 Fr JL4 guiding catheter. The wire, 0.014-inch Sion 180 cm was inserted into the LAD. Pre-dilatation was performed with a SAPPHIRE NC 2.5 x 15 mm balloon and Absorb GT1 BRS 2.5 x 23 mm was deployed at distal LAD lesion. Post-dilation with SAPPHIRE NC 2.5 x 15 mm upto 28 atm (2.75 mm) was done. ( Movie 4) Right coronary artery was engaged with a 6 Fr JR 4 guiding catheter. The wire, 0.014-inch Sion 180 cm was inserted into the RCA. Pre-dilation was performed with a SAPPHIRE NC 2.5 x 15 mm balloon ( Movie 5). And then Absorb GT1 BVS 3.5 x 28 mm and Absorb GT1 BVS 3.0 x 28 mm were successfully deployed at the diffuse RCA lesion with minimal overlap. ( Movie 6, Movie 7) After stenting, we performed additional balloon angioplasty with Raiden 3 NC 3.5 x 20 mm and SAPPHIRE NC 4.0 x 15 mm balloons at the proximal to mid RCA. ( Movie 8, Movie 9) Final angiogram and IVUS showed that the procedure was successful. ( Movie 10)

Appendix
IVUS image of pre-ballooning ( Movie 11), post stent implantation ( Movie 12) and final image ( Movie 13) of RCA.

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