Author + information
- Takuro Yoshio1
Patient initials or identifier number
Relevant clinical history and physical exam
A 68 year-old-man admitted to our emergency room with Non-ST segment elevation myocardial infarction. CAG showed severe stenosis in proximal and distal LCX and moderate stenosis in proximal LAD and proximal RCA. Subsequently, we performed PCI to proximal LCX and DES was deployed. At the one year follow up CAG, there was residual stenosis in distal LCX. Therefore, we performed PCI to distal LCX.
Relevant test results prior to catheterization
The electrocardiography showed sinus rhythm.
Blood test showed, eGFR is 61mL/min.
Echocardiography showed EF 71%.
Relevant catheterization findings
CAG showed no restenosis, but there is residual stenosis in distal LCX.
We performed PCI for distal LCX. We dilated with 2.0 mm Lacross NSE. After that, we tried to remove the balloon, but we felt resistance in the proximal stent. Only the balloon could advance to distal part. Balloon could removed by pulling with wire. After that, Angiogram showed previous stent was shorten by longitudinal deformation.We managed to pass through wire again and we tried to dilate the stent by 2.0 mm balloon, but it could not pass the stent. We changed balloon size to 1.5 mm balloon and could pass the stent. After balloon dilatation, we performed OCT to observe the stent. OCT revealed stent deformation and confirmed the wire within stent. We added balloon dilatation with 3.5 mm balloon. Final angiogram and OCT showed good stent dilatation.
Lacross NSE has three elements and there are some gap between distal tip and adhesive surface. Therefore, It has possibility to trap at the stent strut.we have to use NSE carefully especially performed PCI for distal part of stent.