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Subacute Occlusion at distal Edge of Stent
Beijing Anzhen HospitalCapital Medical University
Wu, Xiaofan
• 63-year-old male
• Sudden onset of CP 4 days after PCI
• Cardiovascular risk factors: DM
• Electrocardiogram: mild ST elevations in V2-5
• TnI↑: 0.8 ng/ml
Clinical Presentation
Previous Angiogram and PCI
• 01/20/01 at other H: AMI (inferior)
pLCX95% → S660 2.5*9mm
• 10/15/09 at Anzhen H: unstable angina
mLAD70% → Cypher select 3.0*33mm
• 10/19/09 at Anzhen H: sudden CP
occlusion at distal edge of stent at mLAD
Baseline AngiogramInitial angiogram on 10/19/09
Occlusion at distal edge of stent at mLAD
Review of previous coronary intervention
A 70% stenosis at mid LAD with diffuse calcium, LCX (-), RCA (-)
Initial angiogram on 10/15/09
Review of previous coronary interventionCoronary stenting on 10/15/09
Pre dilation with a safecut balloon 2.0*15mm
A Cypher stent 3.0*30 mm at mid LAD
Post dilation with a Quantum 3.0*12mm
Review of previous coronary interventionFinal angiogram after stenting on 10/15/09
A haziness at distal edge of stent in mLAD
Baseline IVUS at 10/19/09
A
BC
C
B
A
Coronary intervention on 10/19/09
Pre dilation with a Ryujin balloon 2.5*15mm, occlusion expanded to distal LAD
Coronary intervention on 10/19/09
A Lepu stent 2.5*18 mm and A Lepu stent 2.75*18mm distal to previous Cypher stent, occlusion continued to expand
Coronary intervention on 10/19/09
An Endeavor stent 2.25*14mm at distal LAD
Final angiogram after stenting
Post IVUS at 10/19/09