Subacute Occlusion at distal Edge of Stent

Beijing Anzhen HospitalCapital Medical University

Wu, Xiaofan

• 63-year-old male

• Sudden onset of CP 4 days after PCI

• Cardiovascular risk factors: DM

• Electrocardiogram: mild ST elevations in V2-5

• TnI↑: 0.8 ng/ml

Clinical Presentation

Previous Angiogram and PCI

• 01/20/01 at other H: AMI (inferior)

pLCX95% → S660 2.5*9mm

• 10/15/09 at Anzhen H: unstable angina

mLAD70% → Cypher select 3.0*33mm

• 10/19/09 at Anzhen H: sudden CP

occlusion at distal edge of stent at mLAD

Baseline AngiogramInitial angiogram on 10/19/09

Occlusion at distal edge of stent at mLAD

Review of previous coronary intervention

A 70% stenosis at mid LAD with diffuse calcium, LCX (-), RCA (-)

Initial angiogram on 10/15/09

Review of previous coronary interventionCoronary stenting on 10/15/09

Pre dilation with a safecut balloon 2.0*15mm

A Cypher stent 3.0*30 mm at mid LAD

Post dilation with a Quantum 3.0*12mm

Review of previous coronary interventionFinal angiogram after stenting on 10/15/09

A haziness at distal edge of stent in mLAD

Baseline IVUS at 10/19/09

A

BC

C

B

A

Coronary intervention on 10/19/09

Pre dilation with a Ryujin balloon 2.5*15mm, occlusion expanded to distal LAD

Coronary intervention on 10/19/09

A Lepu stent 2.5*18 mm and A Lepu stent 2.75*18mm distal to previous Cypher stent, occlusion continued to expand

Coronary intervention on 10/19/09

An Endeavor stent 2.25*14mm at distal LAD

Final angiogram after stenting

Post IVUS at 10/19/09