CASE 12: IVUS-guided LAD stent sizing
A 73-year-old male had presented with angina on exertion to our hospital. SPECT-MPI test showed apical and lateral wall ischmeia. He had a history of hypertension, dyslipidemia, ESRD (on dialysis), and paroxysmal atrial fibrillation. Echocardiography showed good left ventricular systolic function (Ejection Fraction of 60%). A coronary angiogram showed 90% stenosis of the mid LAD.
In this case, IVUS images showed eccentric fibrous plaque in the lesion. The mean vessel diameter at the distal part of the lesion was 3.3mm and the lesion length was 26mm. The MLA was 2.77mm2. Therefore, we choose a 3.0mm x 28mm DES. The mean vessel diameter at the proximal part of the lesion was 3.84mm, then we performed post-dilation with a 3.5mm non-compliant (NC) balloon up to 14 atm. Repeat IVUS images showed that the stent was well expanded, and no malapposition and no stent edge dissection was observed. The MSA was 6.37mm2.
- Raber L. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Herat J. 2018;39:3281-3300.