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Case 7: Proximal LAD stent underexpansion and malapposition

Case Presentation

A 55-year-old male came to the outpatient clinic because he had recently become aware of chest and shoulder pain associated with exertion. He had a history of multiple PCI procedures, hypertension, dyslipidemia, hyperthyroidism, and IDDM. Echocardiography showed reduced left ventricular wall motion, with ejection fraction of 42%. SPECT showed ischemia in the inferior wall.

Angio Pre

Coronary angiography revealed a hazy area in the proximal LAD, and when IVUS was performed, malapposition of the stent was observed. Visualized in the image below, the IVUS catheter was found to have crossed the stent through a strut after the proximal edge due to this malapposition. Therefore, the wire was reinserted. Repeat IVUS showed that the wire was no longer entering through a stent strut and a 4.0mm non-compliant balloon was dilated up to 18 atm pressure.

IVUS First Pullback

IVUS After rewiring now within stent

In this case, by confirming the lesion with IVUS, it was found that the wire had passed through a stent strut. Review of the pullback allowed us to reinsert the wire into the stent before balloon dilatation. Thus, if malapposition is present at the proximal edge of the stent, it is possible that the wire has passed through the stent strut and special precaution should be taken to avoid stent deformation.

Angi Post

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.

Left Main DK Crush Video ID