Daegu Catholic University Medical Center

Promus Eliment Stent in Complex Lesion Intervention

Promus Eliment Stent in Complex Lesion Intervention

Presenter : Jin Bae LeeOperator : Kee Sik Kim, Jin Bae Lee

Patient profilePatient profile

• 83-year-old female • Unstable chest pain for 2 days • Risk factor

- Hypertension (20 years)- Diabetes (8 Years)

• AMI at 1993 - thrombolytic theraphy

• 83-year-old female • Unstable chest pain for 2 days • Risk factor

- Hypertension (20 years)- Diabetes (8 Years)

• AMI at 1993 - thrombolytic theraphy

ECGECG

• Cardiac markers (Initial) – CK-MB : 0.3 ng/ml– cTn-I : 0.01 ng/ml

• Echocardiography – Akinesia of basal inferior, mid inferior and apical inferior wall

– LVEF : 41%

• Cardiac markers (Initial) – CK-MB : 0.3 ng/ml– cTn-I : 0.01 ng/ml

• Echocardiography – Akinesia of basal inferior, mid inferior and apical inferior wall

– LVEF : 41%

Clinical diagnosis : Unstable anginaClinical diagnosis : Unstable angina

Left coronary angiographyLeft coronary angiography

Right coronary angiographyRight coronary angiography

CABG of PCI?CABG of PCI?

• 83-year-old female • Triple vessel disease include CTO of LAD• Diabetes• LV dysfunction

• 83-year-old female • Triple vessel disease include CTO of LAD• Diabetes• LV dysfunction

Concern of medical teamConcern of medical team

• Don’t want open thorax• Minimize cost (minimize stent number)• Don’t want open thorax• Minimize cost (minimize stent number)

Concern of patient and familyConcern of patient and family

Finally we decided to perform PCIFinally we decided to perform PCI

Sequent 2.0 X 15mm 20 atmSequent 2.0 X 15mm 20 atm Ikazuchi 2.5 X 15mm 18 atmIkazuchi 2.5 X 15mm 18 atm

LCX PCILCX PCI

Final angioraphy of LCX PCIFinal angioraphy of LCX PCI

Five days later, we tried to CTO of LAD interventionFive days later, we tried to CTO of LAD intervention

LCA - XB 3.5, RCA - JL4 LCA - XB 3.5, RCA - JL4

Bilateral angiographyBilateral angiography

Field FC with CorsarField FC with Corsar

Guide wire introduceGuide wire introduce

Balloon dilataionBalloon dilataion

Ryujin 1.25 X 15mm Ryujin 1.25 X 15mm

IVUSIVUS

Mid LAD Mid LAD Proximal LAD to distal LMProximal LAD to distal LM

Balloon dilataionBalloon dilataion

Fortis 2.5 X 15mm, 18 atm Fortis 2.5 X 15mm, 18 atm

After balloon angioplastyAfter balloon angioplasty

LAD stent deploymentLAD stent deployment

Promus Element 2.5 X 28mm 20 atmPromus Element 2.5 X 28mm 20 atm

LAD stent deploymentLAD stent deployment

Promus Element 3.0 X 24mm 18 atmPromus Element 3.0 X 24mm 18 atm

After stent deplyment After stent deplyment

Stent image Stent image

Stent image Stent image

Adjuvant balloon Adjuvant balloon

Quantum 3.0 X 12mm 20 atmQuantum 3.0 X 12mm 20 atm

IVUSIVUS

Dital edge of stent Dital edge of stent Proximal LAD to distal LMProximal LAD to distal LM

Final angiography of LAD PCIFinal angiography of LAD PCI

RCA PCIRCA PCI

Distal and proximal RCA balloon dilatationDistal and proximal RCA balloon dilatation

Sequent 2.5 X 20mm, 8 atm Sequent 2.5 X 20mm, 8 atm

Distal to mid RCA stentDistal to mid RCA stent

Promus Element 2.5 X 16mm 18 atmPromus Element 2.5 X 16mm 18 atm Promus Element 3.0 X 20mm 18 atmPromus Element 3.0 X 20mm 18 atm

Proximal RCA stentProximal RCA stent

Promus Element 3.5 X 16mm 14 atmPromus Element 3.5 X 16mm 14 atm

Final Angiography of RCA PCIFinal Angiography of RCA PCI

SummarySummary

• Long lesion include CTO was treated with Promus Eliment stent without difficulty.

•Promus Eliment provide good radio opacity despite thin strut which provide good landmark for adjuvant balloon and stent overlapping.

• Long lesion include CTO was treated with Promus Eliment stent without difficulty.

•Promus Eliment provide good radio opacity despite thin strut which provide good landmark for adjuvant balloon and stent overlapping.

PROMUS Element Stent was engineered for superior visibility

PROMUS Element Stent was engineered for superior visibility

Platinum Chromium alloy is a higher density material which provides superior visibility on the thinnest strut stentPlatinum Chromium alloy is a higher density material which provides superior visibility on the thinnest strut stent