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Instant Stent-Accentuated Three-Dimensional Optical Coherence Tomography Guided Selection of Proper Distal Cell for Side Branch Dilatation in Bifurcation Stenting.

Nakao F - Case Rep Cardiol (2015)

Bottom Line: In the bifurcation stenting, the distal rewiring for the side branch postdilatation confirmed by two-dimensional modalities may not lead to favorable results in some cases.If there are two distal cells divided by the link bridging from the carina, the rewiring through the larger distal cell may be recommended for the side branch postdilatation.Detailed confirmation of the rewired cell by the intraprocedural instant stent-accentuated three-dimensional optical coherence tomography is important.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Yamaguchi Grand Medical Center, 77 Ohsaki, Hofu, Yamaguchi 747-8511, Japan.

ABSTRACT
In the bifurcation stenting, the distal rewiring for the side branch postdilatation confirmed by two-dimensional modalities may not lead to favorable results in some cases. If there are two distal cells divided by the link bridging from the carina, the rewiring through the larger distal cell may be recommended for the side branch postdilatation. Detailed confirmation of the rewired cell by the intraprocedural instant stent-accentuated three-dimensional optical coherence tomography is important.

No MeSH data available.


Baseline coronary angiography. (a) Cranial view and (b) caudal view.
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Related In: Results  -  Collection


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fig1: Baseline coronary angiography. (a) Cranial view and (b) caudal view.

Mentions: A 69-year-old man underwent percutaneous coronary intervention (PCI) for stenoses of the left anterior descending artery (LAD) (Figure 1). The ostial-mid LAD was stented with two platinum-chromium everolimus-eluting stents (Promus Premier, Boston Scientific Co.). Additional bail-out stenting was required for the proximal stent-edge dissection. The left main coronary artery-proximal LAD was stented with a 3.5 × 14 mm two-link ten-crown biolimus-eluting stent (Japanese design of Nobori, Terumo). After the guide wire was rewired to the left circumflex artery (LCx) (Figure 2(a)), intravascular ultrasonography (IVUS, OptiCross, Boston Scientific Co.) showed the distal rewiring (Figure 2(b) arrowheads). Intraprocedural iSA3D-OCT made from 2D-OCT (Dragonfly JP and ILUMIEN Optis, St. Jude Medical) showed two distal cells (the connection to carina type) and the rewiring through the smaller distal cell (Figure 2(c)). The larger distal cell located on counterclockwise direction for the smaller distal cell. The second rewiring was the same as the first rewiring. At the third rewiring (Figure 3(a)), the guide wire successfully passed through the larger distal cell (Figure 3(b)). After the kissing balloon postdilatation was performed by simultaneously inflating 3.5 mm and 2.0 mm balloons, the final coronary angiography showed a good result (Figures 4(a) and 4(b)), and the final iSA3D-OCT showed minimized floating struts (Figure 4(c)).


Instant Stent-Accentuated Three-Dimensional Optical Coherence Tomography Guided Selection of Proper Distal Cell for Side Branch Dilatation in Bifurcation Stenting.

Nakao F - Case Rep Cardiol (2015)

Baseline coronary angiography. (a) Cranial view and (b) caudal view.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4465687&req=5

fig1: Baseline coronary angiography. (a) Cranial view and (b) caudal view.
Mentions: A 69-year-old man underwent percutaneous coronary intervention (PCI) for stenoses of the left anterior descending artery (LAD) (Figure 1). The ostial-mid LAD was stented with two platinum-chromium everolimus-eluting stents (Promus Premier, Boston Scientific Co.). Additional bail-out stenting was required for the proximal stent-edge dissection. The left main coronary artery-proximal LAD was stented with a 3.5 × 14 mm two-link ten-crown biolimus-eluting stent (Japanese design of Nobori, Terumo). After the guide wire was rewired to the left circumflex artery (LCx) (Figure 2(a)), intravascular ultrasonography (IVUS, OptiCross, Boston Scientific Co.) showed the distal rewiring (Figure 2(b) arrowheads). Intraprocedural iSA3D-OCT made from 2D-OCT (Dragonfly JP and ILUMIEN Optis, St. Jude Medical) showed two distal cells (the connection to carina type) and the rewiring through the smaller distal cell (Figure 2(c)). The larger distal cell located on counterclockwise direction for the smaller distal cell. The second rewiring was the same as the first rewiring. At the third rewiring (Figure 3(a)), the guide wire successfully passed through the larger distal cell (Figure 3(b)). After the kissing balloon postdilatation was performed by simultaneously inflating 3.5 mm and 2.0 mm balloons, the final coronary angiography showed a good result (Figures 4(a) and 4(b)), and the final iSA3D-OCT showed minimized floating struts (Figure 4(c)).

Bottom Line: In the bifurcation stenting, the distal rewiring for the side branch postdilatation confirmed by two-dimensional modalities may not lead to favorable results in some cases.If there are two distal cells divided by the link bridging from the carina, the rewiring through the larger distal cell may be recommended for the side branch postdilatation.Detailed confirmation of the rewired cell by the intraprocedural instant stent-accentuated three-dimensional optical coherence tomography is important.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Yamaguchi Grand Medical Center, 77 Ohsaki, Hofu, Yamaguchi 747-8511, Japan.

ABSTRACT
In the bifurcation stenting, the distal rewiring for the side branch postdilatation confirmed by two-dimensional modalities may not lead to favorable results in some cases. If there are two distal cells divided by the link bridging from the carina, the rewiring through the larger distal cell may be recommended for the side branch postdilatation. Detailed confirmation of the rewired cell by the intraprocedural instant stent-accentuated three-dimensional optical coherence tomography is important.

No MeSH data available.