Slides
Proximal and distal stent edge ISR treatment using FFR assessment
- Operator : Seung-Jung Park
Proximal and distal stent edge ISR treatment using FFR assessment |
- Operator: Seung-Jung Park, MD |
Clinical history |
A 50 year-old female was presented with effort-related chest pain for 2-months. 2-years ago, she had got PCI at pLAD with Cypher 3.5*18mm. After PCI, she had been stable but 2 months ago, she felt effort chest pain. She had medication including aspirin (Plavix for first one-year) and statin regularly for two years and she had no coronary risk factor. Her resting ECG was normal. |
Baseline coronary angiogram |
1. A right coronary angiogram showed intermediate stenoses in proximal and mid RCA. ( Movie 1) |
Procedure |
Left coronary artery was engaged with an 7Fr JL 4 guiding catheter with side holes. IVUS exam showed severe atherosclerosis at proximal and distal edge of stent with relatively normal in-stent segment between the two stenotic lesions. ( Movie 3) We planned to correct the LAD lesions because the FFR value in mLAD was 0.72 at maximum hyperemia with intravenous infusion of adenosine at 140mcg/kg/min. During maximal hyperemia, the pressure wire was slowly pulled back from the distal part of stent to the proximal part of stent. FFR value of distal part of stent was 0.72, in-stent was 0.76, proximal part of the stent was 0.98. (Figure 1) The ¡â pressure of stenosis at distal edge of the stent was 0.04 in FFR, and the ¡â pressure of stenosis at proximal edge of stent was 0.22 in FFR which was greater than that of distal edge of the stent. Therefore, we decided to treat the stenosis at proximal part of stent first. The proximal edge of stent at pLAD was treated with direct stenting (Xience V 3.5 x 15 mm). ( Movie 4) After correction of proximal stenosis, We measured again FFR to determine the functional significance of distal edge lesion. FFR value in mid LAD was 0.90. (Figure 2) We decided to defer the lesion of distal edge of stent and planned medical treatment. Final angiogram showed a good result with TIMI 3 flow. ( Movie 5) |
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