Hybrid BVS + DES Stenting

- Operator : Seung-Jung Park

Hybrid BVS + DES Stenting

- Operator: Seung-Jung Park, MD

Case Presentation

A 77 years old female patient was hospitalized for dizziness with nausea started 1months ago. Her coronary arterial disease risk factor was dyslipidemia and diabetes. Her physical exam was normal. The electrocardiogram and cardiac enzymes were unremarkable. Echocardiography revealed no regional wall motion abnormality with normal left ventricular systolic function.

Baseline Coronary Angiogram

Left and coronary angiogram showed moderate stenosis at proximal to mid left anterior descending (LAD) and distal left circumflex (LCX). ( Movie 1, Movie 2) The right coronary angiogram showed proximal right coronary artery (RCA) chronic total occlusion (CTO). ( Movie 3)

Procedure

Three days earlier the main procedure to RCA CTO, Xience A 2.75 x 38mm Drug eluting stent (DES) was implanted at proximal to mid LAD ( Movie 4). On the day for main procedure to RCA CTO, 7 Fr sheaths were inserted thorough the left and right femoral artery. Left coronary artery was engaged with a 6 Fr JL 4 diagnostic catheter and RCA was engaged with a 7 Fr guiding catheter. The wire, 0.014-inch 190 BMW was inserted into the RCA through Corsair 2.6Fr micro guide catheter. Pre-dilation performed with a FLUYDO 2.0 x 20 mm balloon ( Movie 5) and Emerge NC 2.5 x 20 mm balloon ( Movie 6). And then Absorb GT1 BVS 3.0 x 28mm, 3.0 x 28mm, and 3.5 x 23mm were deployed at distal to mid part of the RCA ( Movie 7, Movie 8, Movie 9). And Xience A 4.0 x 23mm DES was implanted at proximal part of the RCA ( Movie 10). After stenting, we performed additional balloon angioplasty with Empira NC 3.0 x 20 mm balloon, Raiden3 3.5 x 20mm balloon, and Pantera LEO 4.5 x 8mm balloon ( Movie 11, Movie 12, Movie 13). Final angiogram ( Movie 14) and IVUS ( Movie 15) showed that the procedure was successful.