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    Su Mardi No 2020

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    Su Mardi No 2020

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    Su Mardi No 2020

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    S224 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO.

    16, SUPPL S, 2016

    TCTAP C-111
    Stent Edge Dissection Caused by Hinge Motion in Tortuous Vessels
    Takatoyo Kiko,1 Yoshifumi Kashima,1 Daitarou Kanno,1
    Tomohiko Watanabe,1 Yutaka Tadano,1 Takuro Sugie,1 Ken Kobayashi,1
    Tsutomu Fujita1
    1
    Sapporo CardioVascular Clinic, Japan

    [CLINICAL INFORMATION]
    Patient initials or identifier number. M.O.
    Relevant clinical history and physical exam. A 67-year-old female with
    hypertension and diabetes was admitted to our hospital to be evalu-
    ated for chest discomfort on effort. She hadn’t received any cathe-
    terization yet. On her physical examination, blood pressure was 140/
    70 mmHg and heart rate was 70 bpm.
    Relevant test results prior to catheterization. There were no specific
    findings on electrocardiography and echocardiography.
    Relevant catheterization findings. Coronary angiography revealed focal
    75% stenosis at the proximal right coronary artery (RCA) in tortuous
    vessels. There was no significant stenosis in left anterior descending
    artery and left circumflex artery.
    [INTERVENTIONAL MANAGEMENT]
    Procedural step. Percutaneous coronary intervention (PCI) was per-
    formed from right radial artery. The proximal RCA lesion was dilated
    with a 3.015 mm balloon (HiryuPlus, TERUMO) and treated with a
    3.018 mm biolimus-eluting stent (NOBORI, TERUMO). Intravascular
    ultrasound (IVUS) didn’t show any dissection and intramural hema-
    toma. The final angiography was acceptable. In a general ward after
    the PCI thirty minutes later, she suddenly got chest pain and nausea
    with ST segment elevation in leads II, III and aVF. Emergent coronary
    angiography revealed an occlusion of the proximal RCA in the stent.
    PCI was performed from femoral artery with a 7 Fr Judkins right
    guiding catheter (Launchar, Medtronic) and a guide wire (Sionblue,
    ASAHI Intecc). IVUS showed the stent edge dissection and intramural
    hematoma expanded to the far distal RCA. The true lumen was com-
    pressed by the enlarged, tense, false lumen. We put 2.538 mm and
    3.028 mm everolimus-eluting stents (XienceAlpine, Abott) after
    making the re-entry point by a 3.010 mm cutting balloon (Flextome,
    BostonScientific). Then, RCA flow got TIMI3 and her symptoms were
    getting better. The final angiography was acceptable. She was dis-
    charged after 2 days with no elevation of cardiac enzyme.

    Case Summary.  Stent loss during PCI occurs infrequently in the


    current era (incidence 0.32%) and is more likely to occur in tortuous
    and calcified coronary arteries.
     Lost stents can be successfully retrieved in the majority of cases
    using a variety of retrieval techniques like low pressure balloon
    inflation technique, small balloon technique, double wire technique
    and loop snare technique.
     Stent loss is associated with an increased risk of complications,
    such as significant bleeding and need for emergency coronary artery
    bypass graft surgery.
     Stents lost in small branches can be left.
     If stent is not retrieved it may be deployed or crushed.
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016 S225

    Case Summary. This case represents the possibility that hinge motion
    could make coronary artery dissection at the edge of stent. We found the
    dissection thirty minutes later despite IVUS couldn’t show any injury in the
    first PCI. It may be a risk factor to place stent edge in tortuous vessels with
    hinge motion. Additionally, a biolimus-eluting stent (NOBORI, TERUMO)
    has thicker strut (125 mm) than other second-generation drug-eluting
    stents, which may be also the risk of the phenomenon.

    TCTAP C-112
    A Complex Calcified Lesion: A Lesson Learnt Twice!
    Aaron Wong1
    1
    National Heart Centre Singapore, Singapore

    [CLINICAL INFORMATION]
    Patient initials or identifier number. DDC
    Relevant clinical history and physical exam. 83 year-old man with car-
    diovascular risk factors of DM, HTN and HLP. He had past history IHD
    with previous PCI done in 2000. He presented 3 years ago with recent
    onset of chest tightness on exertion and coronary angiography
    showed triple vessel disease. LAD and RCA were both stented with
    DES. LCX was calcified and diffusely disease and was left for medical
    treatment. 8 months later he presented with exertional angina and he
    was admitted for coronary angiography.

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