30th Annual Meeting of The Egyptian Society of Cardiology

Layth A. Mimish

The Cardiovascular Consultants Group

Jeddah K.S.A.

Debulking Before StentingIs it Really Necessary?

Inadequate initial stent expansion

Guiding Catheter

Standard C curve insertion technique

Avoid deep osteal intubation

Avoid overtorquing

Coaxial alignment

Supportive guidewire

DCA ComplicationsPerforation

Misdirected cutsOversized deviceSpasmWire fractureSevere angulationExtensive dissection

CK ElevationVasospasmSlow / No ReflowProcedural Bleeding

Debulking

Technically more demanding and time consuming

Higher CK rise

Potential increased risk of vascular complications

Limited access in tortous and calcified vessels

Successful DCA

Angiographic resultsPost DCA stenosis =15%

Post PTCA or stent =0%

Smooth borders

Good distal flow

Absence of dissection

Good tissue yield

Residual Plaque Burden Post Stenting & Intimal Hyperplasia

How Aggressive?

Left Main Disease

Flexicut

Instent Restenosis

HSRA for Instent Restenosis

Direct stenting / Drug eluting Stent<10 minutes floroscopy50ml angiographic dye3000 Dollars

IVUSHSRA 3BurrsIV NTG , Isoptin or Adenosine IABPReoproStent IVUS

>60 minute floroscopy

>300-500 ml dye

>10,000 DOLLARS

Is money an issue??

GOOD OLD

BALLOON

IS STILL

A VALUABLE

TOOL

Late Stent Malapposition

Baseline

Follow up

Conclusion