Slides

Diffuse Coronary Lesion of the RCA, Treated with Four TAXUS Stents

- Operator : Charles Chan

Diffuse Coronary Lesion of the RCA, Treated with Four TAXUS Stents

- Operator : Charles Chan, MD, PhD, Singapore
Case Presentation
A 58 year-old male had complaints of effort chest pain for several months. He received stent PCI at proximal LAD ten years ago. His coronary risk factors were hypertension and medically controlled hypercholesterolemia. Thallium SPECT showed reversible perfusion defect in right coronary artery territory.
Baseline Coronary Angiography
The right coronary angiogram showed tight stenosis in long diffuse stenosis from proximal to mid portion(Figure 1, Figure 2).
Procedure
A 7 Fr sheath was inserted through right femoral artery and the right coronary was engaged with a 7 Fr Judkins right catheter. The right coronary artery was wired with a 0.014 inch Floppy wire. Two 3.0 x 12mm Taxus™ stents were deployed into mid portion (Figure 3) and proximal portion of the lesion (Figure 4). Additional 3.0 x 16mm TaxusO stent was inserted between the two stents with overlapping (Figure 5). Then another 3.0 x 24mm TaxusO stent was deployed distal part of the lesion permitting to overlap with distal stent (Figure 6). The following angiogram showed good stent expansion (Figure 7).

Comments

  • xubo 2003-06-20 Would you please give me some information about the long-term result of stents overlapping with TAXUS? Is it safety? Thank you very much.
  • Charles Chan 2003-06-20 Currently, there is not much data regarding the long-term results of overlapping stents. TAXUS IV hopefully will shed some light on this issue. However, from my own personal experience and from TAXUS II, we should overlap the stent and do not leave any uncovered gap between the stent. Also, we should not overlap of DES and bare metal stents. Prof Chane metal
  • Marcelo Ribeiro 2003-06-26 I would like to ask you how is your strategy of deployment considering that some renowned people are still using very high pressure deployment,while others have been quoting about the useless of "the bigger is better concept" in the era of drug eluting stents.Thank you for another outstanding procedure!
  • Charles Chan 2003-06-27 I believe that excessively high pressure dilatation may cause deep arterial injury and resulting in excessive tissue proliferation. Hence, I tend to use maximum 12-16 atm for DES stent deployment. We must also bear in mind the risk of SAT in the short term and therefore the DES stent should be optimally deployed.
  • Gopal P Rakesh 2003-08-27 It appears that the operator has stented nearly 55 to 64 mm of patients coronary artery. With the given pictures lesion doesnot appear that long and it is not that diffuse. Infact the lesion stops beyond an RV branch.Distal RCA is normal. I dont know whether it is worth calling it diffuse. Even with drug coated stents such long metal jackets should be watched with caution. At the same time we are treating normal to normal areas there is definitely a point to avoid treating normal areas.

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