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Case 13: Stent malapposition in ectatic LAD

Case Presentation

A 60-year-old male came from an outside hospital with chest pain as his chief complaint. Coronary angiography was performed by his previous physician which revealed a 2-vessel lesion with ostial LAD 90%, mLAD 80%, and pLCX 90%. He was admitted to our hospital for high risk PCI of LAD. He has a history of chronic diastolic heart failure, hypertension, IDDM, hyperlipidemia, ESRD (on dialysis), and COPD.

Angio Pre

Since the calcification was very severe on angiography, we first performed rotational atherectomy (RA) with a 1.75mm burr. The IVUS after RA showed an ectatic lesion with calcified plaque which could also be confirmed by angiography. The MLA was 3.8mm2, distal reference was 4.1mm x 4.2mm (Lumen), and proximal reference was 6.5mm x 7.1mm (EEL-EEL).

IVUS after RA

After performing pre-dilatation with 4.0mm non-compliant (NC) balloon, we implanted a DES (4.0mm x 38mm) to the lesion (pLAD-dLM). IVUS showed stent malapposition in the proximal edge of the stent due to the ectatic lesion.

Angio after stenting

IVUS post-stent

Although unrecognizable from angiography, the IVUS showed severe malapposition in the proximal part of the stent. To resolve the malapposition, we performed POT with a 5.5mm NC balloon dilated to 20 atm.

Angio Final, after POT 2x

IVUS after POT

In this case, we were able to recognize the stent malapposition and optimize stent placement by using IVUS.

ModelBurst (ATM)Diameter (mm)Balloon Length (mm)              
681215202530
MINI TREK (CTO INDICATED)1.271.2
1.561.5
2.172✓*✓*
TREK2.372.25
2.672.5
2.912.75
3.113
3.53.25
3.73.5
3.943.75
4.324
4.864.5
5.365
*Only available as RX, not as OTW. Other sizes available in both versions.
Retrieved on April 07 2022 from Abbott product ordering information. Please look at the company's files for the latest available data on device configurations and avilability in your area.

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