Lots of interesting abstracts and cases were submitted for TCTAP & AP VALVES 2020 Virtual. Below are accepted ones after thoroughly reviewed by our official reviewers. Don¡¯t miss the opportunity to explore your knowledge and interact with authors as well as virtual participants by sharing your opinion!
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CASE20191114_008
| CORONARY - Drug-Eluting Balloons | |
| An Optical Coherence Tomography Follow-up of a Case of Exertional Angina with Non-Stent Strategy | |
| Satoru Sasaki1, Hiroaki Abe1 | |
| Takatsuki General Hospital, Japan1, | |
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[Clinical Information]
- Patient initials or identifier number:
Mr. M.K.
-Relevant clinical history and physical exam:
A 42-year-old male with untreated dyslipidemia presented to the hospital, complaining of chest discomfort, which was worsened by exertion. He had no history of smoking. On examination the temperature was 36.5 degree, the pulse 54 beat per minute, the blood pressure 134/84 mmHg, the oxygen saturation 98 % in ambient air. He had normal heart sound and the respiratory examination was unremarkable. He was diagnosed as exertional angina pectoris (EAP) by exercise electrocardiography.
-Relevant test results prior to catheterization:
Laboratory data revealed that hemoglobin was 14.8 g/dL, troponin T 0.016 pg/mL, serum creatinine 0.97 mg/dL, serum LDL 129 mg/dL, HDL 57 mg/dL, eicosapentaenoic acid (EPA) / arachidonic acid (AA) ratio 0.04, Lipoprotein (a) 7mg/dL, Hemoglobin A1c 5.5%. Exercise electrocardiography demonstrated ST depression at V5 and V6. Echocardiogram showed normal left ventricular function and no valvular disease.
- Relevant catheterization findings:
The coronary angiography (CAG) showed left coronary artery intact, and severe stenosis at distal right coronary artery (RCA) (Figure 1).
 Figure 1.mp4 |
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[Interventional Management]
- Procedural step:
Percutaneous coronary intervention (PCI) to RCA was performed under optical coherence tomography (OCT) guidance. A 6-Fr sheath was inserted via the left radial artery. The RCA was engaged with a 6-Fr JR 4.0 guiding catheter. The OCT revealed 360-degree lipid rich plaque at the culprit lesion (Figure 2). After dilatation by 2.0 mm semi-compliant balloon and 3.5 mm non-slipping element balloon, a 3.5-mm drug-coated balloon was used. Although final angiogram and OCT showed medial dissection with large intimal flap (Figure 3), the procedure was finished without stenting, because the coronary flow was not limited. Follow-up angiogram 8 months later demonstrated no restenosis. The healed vessel with dense fibrous plaque was recognized by simultaneous OCT (Figure 4).
Figure 2.mp4 Figure 3.mp4 FIgure 4.mp4- Case Summary:
This is a case of EAP, of which the culprit RCA contained lipid rich plaque, treated by stentless method. Even though medial dissection had been anatomically extended, unless no flow limitation, the vessel was completely healed with dense fibrous plaque. This case is suggestive in terms of stentless strategy with a drug coated balloon.
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