The American Heart Hospital Journal
Figure 1: Right Coronary Artery with Total Occlusion Causing ST-segment-elevation Myocardial Infarction
Case Report
Figure 2: Right Coronary Artery After Aspiration with a Manual Aspiration Catheter, and Angioplasty with a 3.5mm Non-compliant Balloon to 22 Atmospheres, a 3mm Cutting Balloon to 12 Atmospheres, and a 3.5mm Cutting Balloon to 12 Atmospheres
Accute occlusion
Dissection with residual stenosis
Left anterior oblique view.
retained a waist in the proximal end of the stent. To fully cover the remaining lesion proximal to this stent, a 4x18mm Driver bare-metal stent (Medtronic) was deployed at 18 atmospheres, overlapping the segment of the previous stent containing the waist. The waist remained unchanged. During post-dilatation with a 4x12mm NC Sprinter (Medtronic), the balloon ruptured at 25 atmospheres. The appearance of the vessel remained unchanged (see Figure 3).
The 6-French sheath was replaced by an 8-French sheath. Rotational atherectomy was performed using the 2mm Rotablator burr (Scimed, Boston Scientific Corporation, Maple Grove, MN) through an 8-French Judkins right 4 side-hole catheter (Medtronic) over a 0.014 Rotafloppy wire (Boston Scientific) (see Figure 4) at 180,000 revolutions per minute (rpm), keeping drops in rpms under 3,000 and run lengths under 20 seconds. Bradycardia was treated with atropine 0.5mg. The device crossed the lesion on the fifth run, followed by two polishing runs. A 4x12mm NC Sprinter (Medtronic) was slowly inflated until the waist suddenly relaxed at 20 atmospheres. After post-dilatation of the entire stented segment at 20 atmospheres, residual stenosis was 10% (see Figure 5). The atherectomized area was not stented since doing so would have created a ‘triple-decker’ stent segment.
Left anterior oblique view.
Cardiac biomarkers drawn before coronary intervention were normal, and peaked six hours later with creatine kinase 1,096U/l (normal range 24–225), creatine kinase-MB 86ng/ml (normal range 0.0–9.0), and troponin T
Summer 2010
4.98ng/ml (normal
Rotational Atherectomy in STEMI 67
Left anterior oblique view. Note residual waist in the proximal part of the lesion and a complex type D dissection distal to the waist.
Figure 3: Right Coronary Artery After Stenting with a 3.5x38mm Bare-metal Stent Distally and a 4x18mm Bare-metal Stent Proximally (with the Stents Overlapped at the Site of the Residual Waist, Both Deployed at 16 Atmospheres), and Post-dilated with a 4mm Non-compliant Balloon that Ruptured at 25 Atmospheres
Persistent stenosis after stenting
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