Author + information
- Ka Lung Chui1
Patient initials or identifier number
Relevant clinical history and physical exam
A 79 years old female.
Known history of HT, hyperlipidemia, IHD
Cath in 2003: LM normal, mLAD 30%, dLCx 60%, occluded PLV for medical treatment
Admitted for recent onset of exertional chest pain, relieved by rest and TNG
PE Blood pressure stable
CVS dual heart sound, no murmur
Relevant test results prior to catheterization
ECG showed LBBB (old)
Relevant catheterization findings
Cardiac cath showed pLAD 70%, dLCx 60%, dRCA into PDA subtotal occlusion, PLV CTO.
IL3.5 guide to RCA
Fielder XT crossed the lesion, exchanged Rinato wire using finecross
Predilated with 2.0 then followed by DEB to RCA
Same IL3.5 guide to LAD
Rinato to dLAD
Predilated with 2.5 mm balloon
Followed by DES 3.0 x 38 to p-mLAD
Angiogram showed satisfactory angiographic result
OCT showed proximal edge dissection with IMH, decided to leave at that time
Readmitted D15 for subacute stent thrombosis
Lesson to learn: most edge dissection on OCT is benign, exception to this is presence of IMH associated with edge dissection, progression of IMH will lead to acute or subacute stent thrombosis.
This case illustrated that presence of IMH in edge dissection may cause acute or subacute stent thrombosis. This needed to be covered if presence. Imaging guidance should be used to guide the stent size and stent length. In general, a longer stent should be selected in order to cover the entry point of the hematoma. Moreover, stent should be deployed at moderate pressure to avoid squeezing of hematoma on both sides.