Author + information
- Received February 17, 2016
- Accepted February 26, 2016
- Published online June 13, 2016.
- aDivision of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Osaka, Japan
- bDivision of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
- ↵∗Reprint requests and correspondence:
Dr. Junya Shite, Nakatsu Hospital, 2-10-39, Shibata, Kita, Osaka, Japan 530-0012.
A 70-year-old woman with stenosis at the bifurcation of the left anterior descending artery (LAD) and diagonal branch (Dx) underwent implantation of a Xience Alpine stent (2.5 × 23 mm; Abbott Vascular, Abbott Park, Illinois) in the LAD under 3-dimensional (3D) optical coherence tomography (OCT) (St. Jude Medical, St. Paul, Minnesota) guidance. 3D-OCT image reconstruction using Intage Realia software (Cybernet, Tokyo, Japan) (1) showed the guidewire crossing position and stent link location. The guidewire crossed the distal stent cell between the strut and carina, separated by the link at the middle of the carina (Figure 1A). Previous experience with stent deformation in the distal LAD after kissing balloon inflation (KBI) (Figure 2A) led us to re-cross the guidewire, aiming for the proximal cell. 3D-OCT showed the guidewire passing through the target cell (Figure 1B). A semicompliant balloon (2.0 × 15 mm) was dilated with 4 atm in the proximal LAD (before crossing the stent cell) and pushed toward the Dx to invert the jailed strut at the carina to the Dx side (Online Video 1). The balloon was advanced over the jailed strut, and KBI was performed at 8 atm. The final 3D-OCT imaging revealed excellent stent opening at the Dx orifice (Figure 1C), with the jailed strut inverted toward the Dx and the stent covering the carina like a folding gate (Figure 1D and 1E).
Jailed struts at the side branch orifice and stent deformation are significant factors for restenosis. If the stent link locates at the side branch orifice and the guidewire crosses the distal cell, stent deformation may occur in the distal main vessel after KBI (Figure 2A). If the guidewire crosses the proximal cell, the jailed strut may remain at the carina even after KBI (Figure 2B). Balloon push-fold with proximal cell guidewire crossing may be effective in this situation.
For a supplemental video and their legend, please see the online version of this article.
Dr. Shite is a compensated consultant for St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 17, 2016.
- Accepted February 26, 2016.
- American College of Cardiology Foundation