OCT bifurcation stenting Ashish Shah 1 Rito Mitra

OCT – bifurcation stenting Ashish Shah 1, Rito Mitra 2 1. University Hospital of Wales, Cardiff, UK 2. Royal Glamorgan Hospital, UK

History • 65 years old man • CCS 3 angina • Myocardial perfusion study • Reversibility in antero-lateral wall • Admitted electively • Diagnostic cath – performed in district general hospital • Elective admission for – PCI to OM 1 – Pressure wire study +/- PCI to LAD / Diagonal

Diagnostic angiogram 1 1. 2. Lesion in OM 1 Lesion in LAD / Diagonal 2

PCI to OM 1 1 1. 2. Vessel wired and ballooned Stented with 2. 25 x 18 mm Biomatrix stent at 16 atm 2

PCI to LAD / Diagonal 1 1. FFR 0. 93 at rest and after 1 minutes of IV adenosine 0. 76 2. Provisional stenting with 3. 5 x 28 mm Biomatrix stent 2

PCI to LAD 1 1. Stented with 3. 5 x 28 mm Biomatrix stent 2. Post dilated with 3. 75 mm NCB 2

Provisional stenting to LAD 1 1. 2. Final cine RAO cranial Final cine RAO caudal 2

Chest pain • One hour after procedure • Patient complained of chest pain, sweaty • ST depression in v 1 -3 • Suspected D 1 flow compromise • Taken back to cath lab

Pre and post procedure D 1 1 1. 2. Pre procedure cine Post provisional stenting of LAD – TIMI 2 flow in D 2 2

PCI to D 2 1 1. 2. Vessel wired Ballooned with 1. 5 and 2. 0 mm balloon through struts of LAD stent

Stent position in diagonal 1 2

PCI to diagonal 1 1. 2. Final kissing after stenting diagonal Final cine 2

OCT – Bifurcation stenting 2 1 1 3

Summary and conclusion • Provisional stenting • Difficult to define ostial origin • Calcified lesion • As flow in D 1 maintained • Flow in D 1 compromised • Required D 1 stenting • Concerned about LAD stent distortion • OCT - confirmed • Ostial strut position of D 1 stent • No deformation of LAD stent