Hybrid BVS + DES Stenting at a Complex Lesion

- Operator : Jung-Min Ahn

Hybrid BVS + DES Stenting at a Complex Lesion

- Operator: Jung-Min Ahn, MD

Case Presentation

A 65 years old male patient was hospitalized for dyspnea on exertion started 2 months ago. His coronary arterial disease risk factor was dyslipidemia only. The cardiac CT showed high calcium score, approximately 1088 points. His physical exam was normal. The ECG and cardiac enzymes were unremarkable. Echocardiography revealed no regional wall motion abnormality with mild left ventricular systolic dysfunction.

Baseline Coronary Angiogram

Left and coronary angiogram showed moderate stenosis at proximal to mid LAD. The FFR of LAD lesion was 0.6 ( Movie 1, Movie 2). The right coronary angiogram showed no significant stenosis at RCA ( Movie 3).

Procedure

An 8 Fr sheath was inserted thorough the right femoral artery and left coronary artery was engaged with an 8 Fr JL 4 guiding catheter. The wire, 0.014-inch 190 BMW was inserted into the LCA. Pre-dilation performed with a Raiden3 3.5 x 20 mm balloon ( Movie 4). And then Absorb GT1 BVS 3.5 x 28mm was deployed at distal part of the target LAD lesion and it crossed over a diagonal and a large septal branch ( Movie 5). And Xience A 4.0 x 33mm DES stent was implanted at proximal part of the target LAD lesion ( Movie 6). After stenting, we performed additional balloon angioplasty with Pantera LEO 4.5 x 15 mm balloon in the Xience stent ( Movie 7). Final angiogram and IVUS showed that the procedure was successful ( Movie 8, Movie 9). Appendix IVUS image of post-ballooning ( Movie 10), post stent implantation ( Movie 11)