Longitudinal stent deformation elongating to left main trunk
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CASE REPORT
Longitudinal stent deformation elongating to left main trunk Kensuke Matsushita • Kentaro Arakawa • Kiyoshi Hibi • Kazuo Kimura • Satoshi Umemura Hideo Himeno
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Received: 28 February 2013 / Accepted: 13 October 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
Abstract A 67-year-old woman was admitted with an acute coronary syndrome. Angiographic examination revealed diffuse severe stenosis of the left circumflex artery. A Pressure Wire Certus (St. Jude Medical, St. Paul, MN, USA) was passed to the second post-lateral (PL) branch. To prevent side-branch occlusion, a SION wire (Asahi Intecc Co., Aichi, Japan) was left in the first PL branch, and a SION blue wire (Asahi Intecc) was placed in the second obtuse marginal branch. We implanted an everolimus-eluting stent (PROMUS Element 2.5 9 24 mm, Boston Scientific, Natick, MA, USA) in the culprit lesion. After retrieving the protection wire in first PL branch with resistance, we performed post-dilatation. However, the intravascular ultrasound images showed that the proximal portion of the implanted stent had elongated approximately 2 mm to the left main trunk (LMT), although the position of the distal edge of the stent was unchanged. We decided to additionally place a stent from the ostium of the LMT to the proximal left anterior descending coronary artery, and a biolimus-eluting stent (NOBORI 3.0 9 18 mm, Terumo Co., Tokyo, Japan) was implanted successfully. Longitudinal stent elongation might be caused by the small number
K. Matsushita (&) K. Arakawa H. Himeno Division of Cardiology, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, Kanagawa 251-8511, Japan e-mail: [email protected] K. Hibi K. Kimura Division of Cardiology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan S. Umemura Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
of links between the hoops of a stent, originally intended to improve deliverability.
Introduction Longitudinal stent elongation is a rare complication, but may lead to unnecessary additional ballooning, stenting or the development of new complications. The operator of percutaneous coronary intervention (PCI) should be aware of this complication and chose an appropriate stent for the procedure.
Case report A 67-year-old woman was admitted to our hospital because of worsening chest pain (Canadian Cardiovascular Society classII) and unstable angina was diagnosed. Angiographic examination revealed diffuse severe stenosis of the left circumflex artery (LCX) and mild stenosis of the middle segment of the left main trunk (LMT) (Fig. 1). PCI was performed on the 6th hospital day. Access was obtained via the right femoral artery, using a 7-French SPB4.0 guide catheter (Asahi Intecc Co., Aichi, Japan). A Pressure Wire Certus (St. Jude Medical, St. Paul, MN, USA) was passed to the second post-lateral (PL) branch to assess the fractional flow reserve of the LMT at the end of the procedure. To pr
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