Authors
Mirzakhamdamov Zh.M.1, 2, Katkov A.A.2, Samochatov D.N.1, Arakelov S.E.1, Maslinkov K.I.1, Troshina A.A.1
1 City Hospital named after V.P. Demikhov, Moscow
2 Pirogov National Medical and Surgical Center, Moscow
Abstract
Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in patients with previously implanted stents require a precise interventional approach. Coronary artery spasm and suboptimal stent deployment are key factors determining both angiographic and clinical outcomes of percutaneous coronary intervention (PCI).
We present a clinical case of treatment of patient T., 50 years old, admitted with the clinical picture of NSTE-ACS 3 years after previous stenting of the right coronary artery (RCA) and the circumflex branch of the left coronary artery (CXL). Coronary angiography revealed occlusion of the RCA stent in the middle and distal thirds. After recanalization and balloon angioplasty, severe spasm of the artery was recorded, significantly distorting its true diameter. Intravascular ultrasound (IVUS) showed insufficient expansion of the previously implanted stent and suboptimal compliance of its size with the vessel diameter. After intracoronary 100 mcg nitroglycerin and IVUS navigation, stenting of the RCA and posterior interventricular branch (PIV) was performed with three drug-eluting stents, followed by postdilation with a non-compliant balloon. Control IVUS confirmed optimal expansion of the stents along their entire length; final antegrade blood flow TIMI 3.
Conclusion. The combined use of intracoronary vasodilators and IVUS allows for differentiation of the causes of previously implanted stent occlusion, appropriate device size selection, elimination of angiographic artifacts caused by coronary spasm, and optimal PCI outcomes. This observation confirms the feasibility of routine intravascular imaging in complex reoperations.
Keywords: percutaneous coronary intervention, non-ST-segment elevation acute coronary syndrome, coronary artery spasm, intravascular ultrasound (IVUS), intracoronary nitroglycerin, stent reocclusion, stent optimization.
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