Clinical History:

55 Yrs Male.

DM

Previous CAG 2009, Class II Angina

TMT Positive for inducible ischaemia

Normal LV Function by 2D Echo

CAG

● CAG at Right Radial Approach

● LAD after D1 50% lesion, Proximal Calcium.

● D1 - Medina : 0,0,1 , Tight Stenoses with Calcium.

Strategy:

Deploy Absorb - BVS after POBA to D1

PCI

Hardware:

• Rt Radial approach

-6F Teurmo sheath, Guiding: EBU 3.5-6F,

• Guide wire:

-BMW – to D1.

• QCA: D1 80% stenosis, Diameter: 2.5mm, length: 15mm.

PCIPOBA done with 2.5x10 NC at 10 atm Sub-intimal staining at the lesion and

branch site

PCI

•BVS –

Absorb 2.5 x 18mm.

Scaffold deployed

● Absorb – BVS deployed at nominal press. of 7 atm – 30sec with incremental pressure of 2 atm at 5 sec interval.

PCI

● OCT checked calcium with fibro-fatty plaque is present at the site of

lesion and distal .

OCT did show under expansion at distal part of lesion and sub intimal collection

PCI● High Pressure dilatation with 2.5x10 and 2.75x15 NC Balloons at 12 atm done for complete apposition of Scaffold.

PCI● OCT showed better apposition and sub intimal staining decreasing.

● Side branch well protected.

PCI

• LAO Cranial View provided a better impression of stent apposition,

Message

BVS Absorb needs proper bed preparation with NC Balloon for calcific lesions.

High Pressure Dilatation with sub Intimal Collection can lead to vessel damage and perforation.

OCT guidance is obligatory for Absorb BVS.

THANK YOU