30 th annual meeting of the egyptian society of cardiology
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30th Annual Meeting of The Egyptian Society of Cardiology
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Layth A. Mimish
The Cardiovascular Consultants Group
Jeddah K.S.A.
Debulking Before StentingIs it Really Necessary?
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Inadequate initial stent expansion
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Guiding Catheter
Standard C curve insertion technique
Avoid deep osteal intubation
Avoid overtorquing
Coaxial alignment
Supportive guidewire
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DCA ComplicationsPerforation
Misdirected cutsOversized deviceSpasmWire fractureSevere angulationExtensive dissection
CK ElevationVasospasmSlow / No ReflowProcedural Bleeding
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Debulking
Technically more demanding and time consuming
Higher CK rise
Potential increased risk of vascular complications
Limited access in tortous and calcified vessels
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Successful DCA
Angiographic resultsPost DCA stenosis =15%
Post PTCA or stent =0%
Smooth borders
Good distal flow
Absence of dissection
Good tissue yield
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Residual Plaque Burden Post Stenting & Intimal Hyperplasia
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How Aggressive?
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Left Main Disease
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Flexicut
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Instent Restenosis
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HSRA for Instent Restenosis
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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
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Is money an issue??
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GOOD OLD
BALLOON
IS STILL
A VALUABLE
TOOL
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Late Stent Malapposition
Baseline
Follow up
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Conclusion