Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 50-year-old male presents with stable angina symptom. There is no heart failure symptom. Physical exam shows BP 140/80 and P 70/min. Heart sound is normal with no murmur. Chest is clear. Bilateral radial pulses have no delay.
Relevant test results prior to catheterization
Blood test including cardiac markers, CXR, ECG and Echo are unremarkable.
Relevant catheterization findings
LM normal mid-LAD long lesion with maximal 80% stenosis.
LCX and RCA are normal.
We decide to perform stenting with BVS. OCT shows the lesion length is 39 mm and lesion size is ∼3 mm. We choose 2 BVS of 2.5 x 28 mm and 2.5 x 12 mm, aiming for a 1 mm stent minimal overlap.The trick is to understand well about the distance from balloon markers and bead markers to stent edge. The distance between proximal stent edge to proximal bead marker is 0.8 mm after deployment of stent, while the distance between distal stent edge and distal bead marker is 0.3 mm.
We first deploy the 2.5 x 28 mm BVS distally, then deploy the 2.5 x 12 mm BVS proximally when the distal balloon marker is just distal to the proximal bead marker of the distal stent (mid part of balloon marker coincides with the distal edge of bead), such that the distal bead marker of proximal stent is nearly touching the proximal bead marker of distal BVS. This will result in a ∼1 mm BVS stent overlap.
In OCT, we can see there are 5 phases from distal to the proximal stent. In the first phase, normal stent struts of distal BVS are seen. In the second phase, there are 2-3 frames of stent strut loosening, corresponding to the last stent coil of the distal stent. In the third phase, there are 4-5 frames of stent overlap, corresponding to the ‘1 mm’ BVS overlap. In the fourth phase, there are again 2-3 frames of stent strut loosening, corresponding to the distal coil of the proximal stent with no more stent strut from the distal stent seen. In the fifth phase, there are normal stent struts of the proximal BVS.
We finish this case by performing post-dilatation with NC balloon under OCT guidance.
This case demonstrates the technique of minimal BVS overlap. It also illustrates the use of OCT appreciating the perfect BVS overlap, and its role in optimizing BVS post-dilatation.