30 th annual meeting of the egyptian society of cardiology
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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
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