Case 14: Stent malapposition and underexpansion in RCA
A 54-year-old male had been admitted to our hospital with exertional chest pain and a history of prior MI, hypertension, hyperlipidemia, and multiple PCI procedures. Echocardiography showed reduced left ventricular wall motion in the posterior and infer walls, with Ejection Fraction of 45%. Coronary angiography revealed 70% stenosis at the proximal RCA (in-stent restenosis, previous stent was 4.0mm DES).
Angio Post High-pressure PTCA
In this case, IVUS revealed inadequate stent expansion in the site that appeared to be fine on angiography. IVUS often provides information that is not available or less clear on angiography alone.
Whether stent malapposition is harmful or harmless is still debatable, but the presence of stent malapposition in the proximal edge of the stent could allow a guidewire to pass through the stent strut during future PCI leading to serious deformation by guidewires, balloons, catheters, etc.