Author + information
- Received March 1, 2018
- Accepted March 6, 2018
- Published online May 21, 2018.
- Yuichi Nakamura, MD, PhD,
- Yu Kataoka, MD, PhD∗ (, )
- Yasuhide Asaumi, MD, PhD,
- Teruo Noguchi, MD, PhD and
- Satoshi Yasuda, MD, PhD
- ↵∗Address for correspondence:
Dr. Yu Kataoka, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
An 85-year-old man with chronic kidney disease (estimated glomerular filtration rate 28.9 ml/min/1.73 m2) underwent percutaneous coronary intervention with optical coherence tomographic (OCT) guidance (ILUMIEN OPTIS, Abbott Laboratories, Abbott Park, Illinois) using low–molecular-weight dextran for de novo stenosis and in-stent restenosis within the previously implanted bare-metal stent. Pre–optical coherence tomography imaging visualized lipid-rich plaque and in-stent neoatherosclerosis. Furthermore, plaque rupture was observed at the proximal segment of the left anterior descending coronary artery (Figure 1, Online Videos 1, 2, 3, 4, 5, and 6). Following drug-eluting stent implantation at the lipid-rich plaque, we attempted to cover both neoatherosclerotic and ruptured lesions with another drug-eluting stent. Because any angiographic feature corresponding to plaque rupture was invisible, we used the OCT transducer as a marker to identify healthy site for optimal proximal stent landing site. The transducer was manually positioned at the proximal site to the ruptured lesion under 30-ml low–molecular-weight dextran continuous infusion. Contrast angiography visualized the corresponding proximal stent landing site. Both culprit and ruptured lesions were successfully treated with 2 drug-eluting stents.
Optimal stent implantation requires identification of a stent landing site where the least amount of plaque exists. Whether this is possible with an OCT catheter remains unknown. In our case, we continuously infused 30-ml low–molecular-weight dextran, which enabled manual pull-back with clear images for 11 s. Throughout this procedure, we meticulously placed the OCT transducer at the appropriate landing segment and then identified its corresponding site on coronary angiography. This is an applicable procedure with an OCT catheter to select a specific stent landing site when full coverage of the entire lesion is required.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 1, 2018.
- Accepted March 6, 2018.
- 2018 American College of Cardiology Foundation