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Al Zahra Team

Enhanced stent visualization assists in improving the outcome of complex PCI in STEMI setting

Al Zahra Hospital, Dubai, U.A.E

Dr. Behrad Elahi MD, Interventional Specialist Cardiologist, Dr. Rajeev Lochan, MBBS, MD,DM(Card) Consultant interventional Cardiologist, Head Cardiology, Pavithra M Ramesh, Chief Technician

Introduction

Accurate and safe deployment of medical devices at high-risk critical locations in coronary arteries continue to be a challenge in Cath lab. In addition, the amount of contrast injected in diabetic and hypertensive patients during complex procedures is always a concern. Imaging tools play an essential role in the successful utilization of balloon expandable stents. It assures the correct initial positioning and complete deployment at the time of balloon expansion. A case study from Al Zahra Hospital, UAE presents how ClearStent assisted in providing appropriate positioning, accuracy and confidence in multiple stent positioning in bifurcation. It also provides assessment with the deployment of multiple stents in LM setting.

Ulcerative significant distal LM lesion with thrombotic lesion of ostial LAD

Figure A1-2: Ulcerative significant distal LM lesion with thrombotic lesion of ostial LAD

Case presentation and investigation

  • 50 years old man brought by DCAS
  • Ongoing severe angina and sweating four hours duration (2am) and history of on and off chest pain for 7 days.
  • Risk factor: DM and HTN
  • On P/E V/S BP 140/100 mmHg PR 90 bpm Sat: 96% Heart: S1-S2, S3. Lungs: fine basilar hales at the base of RLL
  • ECG: o STE In V1-V3 + STD and TWI V4-V6
  • Beside Echo: LVEF: 35%-40% + RWMA in LAD territory

Percutaneous Coronary Intervention (PCI) treatment

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Figure_B_direct_stenting

Figure B Direct Stenting

Step 1: Stenting

Figure_B_direct_stenting
Figure_C1-2_POT_and_Utilization_of_ClearStent
Figure_D_Compromised_LCX
Figure_E_Re-wiring_and_POBA
Figure_F_and_Figure_G_Dissection_of_LCX_ClearStent_to_visualization
Figure_H_stenting_of_LCX_figure_I_post_dilation_Clearstent
Figure_J1-2_kissing_baloon_technique
Figure_K_1-2_re_pot_performed_for_assistance
Figure_L_final_result
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Al Zahra Team

Discussion

ClearStent was particularly helpful in positioning post dilatation balloon. When contrast was injected, it confirmed good apposition of struts to the vessel wall. The extent of overlap, when 2nd stent was deployed in mid LAD could be confirmed, before and after deployment.

Conclusion

  • Urgent LM PCI can be done safely even IVUS Catheter is not available in your Cath lab for any reasons.
  • Make plan and strategy before proceeding PCI.
  • Use all the necessary instruments and techniques to increase the safety of complex procedure.
  • Using stent enhancer system ESV PCI compared to standard PCI reducing the rate MACE.

  Contact

<p>Dr.Behrad Elahi | MD</p><p>Interventional Cardiologist&nbsp;</p>

Dr.Behrad Elahi | MD

Interventional Cardiologist 

Al Zahra (PVT) Hospital, Dubai-UAE

      

<p>Dr. Rajeev Lochan | MBBS, MD, DM</p><p>Consultant Interventional Cardiologist</p><p>Head Cardiology</p>

Dr. Rajeev Lochan | MBBS, MD, DM

Consultant Interventional Cardiologist

Head Cardiology

Al Zahra (PVT) Hospital, Dubai-UAE