Enhanced stent visualization assists in improving the outcome of complex PCI in STEMI setting

Accurate and safe deployment of medical devices at high-risk critical locations in coronary arteries continue to be a challenge in Cath lab. In addition, the amount of contrast injected in diabetic and hypertensive patients during complex procedures is always a concern. Imaging tools play an essential role in the successful utilization of balloon expandable stents. It assures the correct initial positioning and complete deployment at the time of balloon expansion. A case study from Al Zahra Hospital, UAE presents how ClearStent assisted in providing appropriate positioning, accuracy and confidence in multiple stent positioning in bifurcation. It also provides assessment with the deployment of multiple stents in LM setting.

• 50 years old man brought by DCAS
• Ongoing severe angina and sweating four hours duration (2am) and history of on and off chest pain for 7 days.
• Risk factor: DM and HTN
• On P/E V/S BP 140/100 mmHg PR 90 bpm Sat: 96% Heart: S1-S2, S3. Lungs: fine basilar hales at the base of RLL
• ECG: o STE In V1-V3 + STD and TWI V4-V6
• Beside Echo: LVEF: 35%-40% + RWMA in LAD territory

Discussion

ClearStent was particularly helpful in positioning post dilatation balloon. When contrast was injected, it confirmed good apposition of struts to the vessel wall. The extent of overlap, when 2nd stent was deployed in mid LAD could be confirmed, before and after deployment.

Conclusion

• Urgent LM PCI can be done safely even IVUS Catheter is not available in your Cath lab for any reasons.
• Make plan and strategy before proceeding PCI.
• Use all the necessary instruments and techniques to increase the safety of complex procedure.
• Using stent enhancer system ESV PCI compared to standard PCI reducing the rate MACE.