Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 67 year-old gentleman with history of hypertension, presented with chest pain of one hour duration, with rapid deterioration to Cardiogenic Shock within a few minutes of admission. ECG showed normal sinus rhythm with ST-T changes suggestive of acuteischemia. ECHO showed concentric hypertrophy of the Left Ventricle (LV) with no regional hypokinesia and adequate LV function.
Relevant test results prior to catheterization
Haemogram, Renal Function Test and Serum Electrolytes were within normal limits. The serology for HIV, HBsAg, HCV, and VDRL were also negative.
Relevant catheterization findings
Coronary Angiogram revealed a long segment lesion in the left anterior descending artery (LAD) from proximal to mid segment with stenosis from 80%- 90%. The Right Coronary Artery and the Left Circumflex were both normal.
The LAD was cannulated with a 6Fr EBU catheter. A 0.014″ Whisper XT was the chosen guide wire to cross the lesion. The LAD was diffusely diseased with diameter from the proximal to the distal LAD tapering from 3 mm to 2.5 mm. Therefore we chose to use an a 3-2.5 x 60 mm BioMime Morph Stent. After adequately dilating the vessel, we deployed the stent at 10 atm pr. The stent post-dilated with 3 x 12 mm non-compliant balloon at 15-18 atm pr. TIMI 3 flow was established with well apposed stent as confirmed by the stent-boost.The stent morphed into the LAD did not alter the vessel anatomy, was haemodymaically stable and asymptomatic.
At follow-up, 2 years after the index procedure, the patient is absolutely comfortable and asymtomatic.
The branching coronary arteries tend to taper and thus anatomically designed tapered stents may prove to be better in terms of stent conform ability without altering the vessel anatomy. Long diffused lesions can be better treated with single long stents to minimize binary re stenosis and associated adverse events. They are also convenient from procedural perspective and are economical.We have used these long tapered stents in over forty patients with follow up over two years. we recommend the availabilty of these stents in the treatment armamentarium since long diffuse lesions are not uncommon.