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Relevant clinical history and physical exam
A 78 year-old male had a history of hypertension and COPD. He presented to our hospital with a 1 month history of body weight loss. Contrast-enhanced computed tomography revealed a 53 mm thoracic saccular aneurysm. So he underwent thoracic endovascular aortic repair(TEVAR) to treat thoracic saccular aneurysm.
Relevant test results prior to catheterization
After the TEVAR, Right external iliacartery (EIA) dissection was occurred caused by the tip of the sheath. Thepatient received bare metal stent (BMS) implantation at the artery (EPIC 9.0mm×60mm).
Relevant catheterization findings
However, his lower limb arteries were not observed well by contrast. Completely denuded intimal flap occluded the proximal edge of the first stent. We implanted another EPIC stent (12.0 × 60 mm) in the proximal part of the first stent to cover the intimal flap.
As a matter of fact, the guide wire crossed the proximal edge strut of first stent. So the second stent deployed thorough the strut of first stent. IVUS showed that the second stent obviously did notdilated sufficiently. We performed post-dilatation with a 9.0 mm non-compliant balloon (NCBA). After ballooning, IVUS was performed to check that the second stent dilated sufficiently and there were no stent mal apposition. The final angiography showed a good result without any complications.
Through the experience of our case, we conducted an experiment to investigate the suitable balloon size and pressure in order to break stent strut of each manufacturer.
For example, in case of EPIC stent, we need post-dilatation of 5.0 mm NCBA to dilate and break the edge stent strut. On the other hand, we need post-dilatation of 9.0 mm NCBA to dilate and break the mid strut of the stent.
We sometimes need enough expansion of stent strut in Endovascular Treatment. It can be very useful we understand structures of each stents and know the suitable balloon size and balloon pressure to break stent strut.