Cross-Sectional and Longitudinal Positive Remodeling After Subintimal Drug-Eluting Stent Implantation

Abstract

A 50-year-old man with a history of smoking and hyperlipidemia, but no chest pain, was admitted because of an abnormal electrocardiogram and regional wall motion abnormality on echocardiography (mild inferior hypokinesis). Coronary angiography revealed 2 chronic total occlusions (CTOs): ostial right coronary artery (RCA) and mid left circumflex artery. C A B Figure 1. Baseline Coronary Angiogram and Subintimal Wiring (A) An extremely long chronic total occlusion (CTO) from the ostium of the right coronary artery (RCA) to the distal bifurcation (arrowheads) was seen in the pre-interventional angiogram. The contralateral injection showed an epicardial collateral from left anterior descending coronary artery to the RCA. (B) The CTO was successfully crossed using a retrograde approach via this epicardial collateral combined with the intentional creation of subintimal lumen using a stiff guidewire. Coronary angiography showed a large coronary dissection in the proximal RCA. (C) The intravascular ultrasound catheter (white arrow in B) was placed in the subintimal space, and the true lumen was collapsed at the 2-o'clock position.

Correlation of Angiographic and Anatomic Findings with the Study of Intracoronary Pressure Wire in Patients with Intramyocardial Bridges Presenting Different Clinical Profiles

“…Nevertheless, treatment decision is harder in symptomatic patients when outcomes are not always favorable, especially in those who are candidates for stent revascularization [6] or surgery [7]. In this regard, stent implantation is related to perforation during the stent deployment [8], fracture [9] or thrombosis [10,11] and also with repetitive stenosis [12]. In these patients the correlation between anatomic and hemodynamic parameters has not been analyzed, though it would help in management decision.…”

Impact of Selection Preference on Longer-Term Outcomes between Bioresorbable Vascular Scaffold versus Everolimus-Eluting Stent for True Lumen Tracking-Recanalized Chronic Total Occlusion

“…With the presence of a sizable subintimal space, metallic drug-eluting stents (DES) could be the preferred device for implantation by most CTO interventionists, although its negative long-term effects in such a situation have been reported. 8) Therefore, this could be the main cause that leads to the selection bias regarding the application of BVS or DES to CTO lesions. Nevertheless, this issue had been less explored in real-world BVS-CTO studies.…”