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Call for CASES

Call for CASES. Krzysztof Milewski Motaz AbuSamra CCU, Upper-Silesian Center of Cardiology, Silesian Medical School, Katowice, Poland Head of Department: Pawel Buszman, MD, FESC, FSCAI. MSCT for LMCA stenting follow-up. Introduction.

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Call for CASES

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  1. Call for CASES Krzysztof Milewski Motaz AbuSamra CCU, Upper-Silesian Center of Cardiology, Silesian Medical School, Katowice, Poland Head of Department: Pawel Buszman, MD, FESC, FSCAI MSCT for LMCA stenting follow-up

  2. Introduction • Routine coronary angiography is strongly recommended after LM stenting. • MSCT- a noninvasive method to detect ISR after LM stenting would be of evident clinical value. • In thiscase we present the potential of MSCT for detecting LM ISR

  3. Description of the problem 56-years old man after LM stenting(TAXUS; Boston Scientific) admitted to ICCU to be controlled by coronary angiography and MSCT • Medical History: • Lateral wall myocardial infarction and PTCA OM with stent implantation(2005) • PTCA-LM with DES implantation (2006) • Risk factors: hipertonia arterialis, obesitis, familly history, current smoker • Concomitant treatment: ASA,Ticlopidin, B-blocker, ACE, statin • ECG: Q wave in II, III, aVF and T wave inversion in I, II,aVL, V5, V6. • LVEF assessed by echocardiography: 62%.

  4. Baseline coronarography • Coronary angiography performed at 03.2006 showed: • significant LM stenosis • in stent restenosis (obtuse marginal)

  5. Administration of ticlopidine and ASA. Routine anticoagulation during procedure. Guiding catheter: Judkins Left 4.0 7F. Taxus stent (4.5x12mm) implantation to the LM ostium under the pessure of 18-24 atm (direct stenting).Residual stenosis 0% POBA in OM (2.5x30mm) under the prussure of 14 atm. Residual stenosis 0% PCI procedure

  6. After PCI • wide LM without residual stenosis • No residual stenosis in obtuse marginal • No dissection • TIMI 3

  7. Seven months f-up LM • Seven months later the patient was controlled by coronary angiography and MSCT • There was no restenosis in LM.

  8. Seven months f-up LM LM The MSCT shown high quality of silds with stent in LM

  9. Summary • A 54 year old male after LM stenting was admitted to ICCU for controll coronary angiografy and MSCT. • Seven months after LM stenting coronary angiography and MSCT showed no stenosisin LM after DES implantation. • Current MSCT technology allows reliable noninvasive evaluation of selected patients after LMCA stenting with high quallity of slids ofbig vessels. • MSCT is safe to exclude left main ISR and may therefore be an acceptable first-line alternative to CCA.

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