Lin

The 53 years old male, a heavy smoker who presented with history of type 2 diabetes mellitus, hyperlipidemia and acute  non-ST elevation type myocardial infarction, coronary artery disease, triple vessel disease and percutaneous coronary intervention with stented for left circumflex artery and right coronary artery. He presented with left arm soreness for 2 months and positive of myocardial ischemia on treadmill scan. 

Coronary angiogram showed a critical stenosis of right coronary artery-PDA and a tight de novo lesion of left anterior desending artery, coronary ectasia of left circumflex artery. 

Our target was the tight LAD lesion. We approached from left snuffbox and using EBU 3.5 guiding catheter support. We used Abbott Pilot 50 workhorse wire crossing the LAD lesion. Then, we did the OCT image first. The OCT image showed tight lesion of LAD with minimal lumen area=2.2mm2 with a lipid rich plaque. Then, we pre-dilated with a Emerge3.0x20mm balloon to 6atm first and followed with a Boston DES Synergey 3.0x48mm to 11atm. We post-dilated with Emerge 4x20mm to 14atm. We wanted to delivery a NC ememerge 4.5x15mm balloon but failed. Therefore, we delivered a Boston external catheter 6Fr Guidezilla extension catheter for support. After manipulation, we successfully passed the NC emerge 4.5mmx15mm balloon and dilated with 18atm. The post-stenting OCT clearly showed the proximal stent deformation which related to the Guidezilla extension catheter. 

first stent deformation_3D reconstruction.avi
Second stent coverage_flythrough.avi

Extension catheter is a very good tool for improved the support during PCI. However, there was a potential risk of the deep seating external catheter such as stent deformation which demonstrated in our case. Stent deformation may be under-recognized by fluoroscopy and OCT imaging demonstrated a clear image of Mal-apposed deformed stent. We treated with aggressive post dilatation and additional stent. The result was optimal.