IVUS guided PCI with MagicTouch SCB - Concept Medical

IVUS guided PCI with MagicTouch SCB

A 59-year old Asian gentleman presented with non-ST segment elevation myocardial infarction in the background of previous angioplasty to left-circumflex (LCx) and left anterior descending (LAD) arteries in 2012. The LCx was treated with a 3.0 x 28 mm DES and the LAD with a 3.0 x 18 mm DES. He was haemodynamically stable. The angiogram from the right radial artery demonstrated a patent stent in the LAD, but there was a severe ISR of the stent in LCx. Right coronary artery did not have any significant disease

We proceeded to intervene on the LCx-ISR. After crossing with a Sion blue workhorse wire, we performed intra-vascular ultrasound (IVUS), which revealed the stent was significantly undersized for the vessel size. The vessel diameter distal to the stent was 4.5 mm and the proximal vessel was 5.0 mm. This explained the mechanism of ISR. The distal aspect of the stent was optimized with a 4.5 mm non-compliant balloon and the proximal part with a 5.0 mm NC balloon. We repeated the IVUS, which showed good stent expansion, and hence we decided to use a DCB (4.0 x 30 mm MagicTouch) over another stent. In the end, we achieved a good angiographic result with TIMI3 flow and no obvious dissection or recoil. The patient was discharged on dual antiplatelet therapy for 12-months.