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Call for CASES

Detailed case study of a 56-year-old man with LM stenosis and RCA occlusion who underwent successful ULMCA stent implantation followed by renal stent treatment for stent recoil, demonstrating efficacy and feasibility.

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Call for CASES

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  1. Call for CASES Motaz AbuSamra Krzysztof Milewski CCU, Upper-Silesian Center of Cardiology, Silesian Medical School, Katowice, Poland Head of Department: Pawel Buszman, MD, FESC, FSCAI Stent recoil after LM stenting

  2. Description of the problem • 56-years old man with unstable angina pectoris reffered to ICCU at Upper Silesian Heart Center beacuse of LM disease and CTO of RCA. • Medical History: • Inferior Myocardial Infarction (2000). • Risk factors: hipertonia arterialis. • Concomitant treatment: ASA, isosorbide mononitrate, B-blocker, ACE, statin • ECG: Q wave in II, III, aVF and T wave inversion in III, aVF. • LVEF assessed by echocardiography: 60%. • Enzymes: Troponin: negative CPK-MB: 9 U/L Euroscoure : 2

  3. Baseline coronarography Coronary angiography showed severe LM stenosis and RCA occlusion (Syntax score = 3 ) Consultants’ Team (Interventional cardiologist and Cardiac Surgeons) decided to send the patient for ULMCA stenting.

  4. 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 atm (direct stenting). Residual stenosis c.a. 50%- stent recoil phenomenon. PCI procedure

  5. PCI procedure • Renal stent (NEFRO, Balton) implantation into thepreviously implanted Taxus stent • Size: 5,0x8mm • Inflation pressure: 16 atm

  6. After PCI • Residual stenosis: 0%. • TIMI flow: 3 • No complication. • No ECG changes in comparison with baseline. • Two days after the procedure patient was discharged in good health with no complication.

  7. Seven months f-up • Seven months later the patient was controlled with coronary angiography • There was no restenosis in LM. • CCS class: I

  8. Similarity of ostial LM and renal artery disease • Similarities in vessel wall structures • Fibrotic/calcified lesions • Large vessels (>5mm) • Elastic recoil • 40-50% coincident rate • The same type of disease? • PTA/PCI: large stents with high radial forces/support, delivered under high pressure

  9. Summary • A 56 year old male with unstable angina was admitted to the hospital for interventional diagnosis and treatment. • Coronary angiography showed severe LM stenosis • After TAXUS stent implantation the recoil phenomenon was observed. It was succesfuly treatet with renal „NEFRO” stent implantation • Patient left hospital on combined antiplatelet therapy with aspirin and ticlopidine ordered for 6 months. • After 7 months patient was angiographically controlled and no LM stenosis was observed • Application of renal „NEFRO” stent is feasible and efficient for leasions locaeted in LM with high elastic force

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